Categories: ASD and DD, Child-focused
By Jennifer Zarcone, Ph.D., BCBA-D
[The following column was published in the Randolph Herald on 4/1/20]
Many parents of children with autism struggle with the decision to use psychotropic medication to address their child’s behavioral concerns. Although evidence-based treatments such as applied behavior analysis have proven to be extremely effective for children with autism, medications can sometimes be a helpful addition to a comprehensive treatment package.
To date, there are two medications that have been FDA approved to treat irritability in children with autism: Risperdal® (risperidone) and Abilify® (aripiprazole). These are antipsychotic medications and there have been several positive studies on their effectiveness (see references below). However, there are no medications specifically designed for the treatment of autism, and most medications have not been directly tested with children with autism. It is important to note that no medication can cure autism. Parents must be very skeptical of any advice to the contrary.
When considering whether to start a medication or make a change in medication, parents should have a clear conversation with their medical provider and ask the following questions:
When starting a new medication, it is important to keep the same behavioral interventions and data collection methods in place so good decisions can be made about whether the medication is helping. If too many things are changed at once, it is difficult to tell which event had the biggest impact on the child’s behavior. Thus, we recommend making one change at a time.
Since there is so little information available about which medications work best for children with autism, parents must work closely with their medical provider to make informed decisions about which medication to try and when to make any medication changes.
Some parents may want to try alternative therapies such as vitamins or supplements to address behavior problems because they believe these products may be effective or less harmful than traditional medications. Unfortunately, there is very little research to support the use of vitamins or supplements in the treatment of problem behavior. Additionally, vitamins and supplements may have side effects and may interfere or interact with other medications.
Decisions about using medications for behavioral issues are complex and parents should learn as much as they can about them so they can be informed consumers. They should work closely with physicians and take many factors into account when selecting medications, including the age of the child, dosage, side effects, medication interactions, and the duration and maintenance of the medication regimen.
As noted above, some medications have been found to be helpful for children with autism and it is important to be informed, make data-based decisions, and keep an open mind when starting any new treatment, including medication.
Recommended reading for parents:
Schall, C. (2002). A consumer’s guide to monitoring psychotropic medication for individuals with Autism Spectrum Disorders. Focus on Autism, 17 (4), 229-235.
There are several classes of medications that may benefit a child with autism:
ANTI-DEPRESSANTS:
A group of medications designed to reduce depressive symptoms that may also be helpful with repetitive, ritualistic, and compulsive behaviors. These are called selective serotonin reuptake inhibitors (SSRIs), and include Prozac®, Zoloft®, Lexipro®, Celexa®, Luvox®, and Anafranil®.
ANTI-PSYCHOTICS (NEUROLEPTICS):
These medications may be used for severe aggression and self-injury. The most typically prescribed antipsychotics are Risperdal®, Zyprexa®, Seroquel®, Abilify®, and Geodon®.
ANTI-CONVULSANTS:
Depakote®, Tegretol®, Lamictal®, Neurontin®, and Topamax® are often used to treat seizure disorders, but are also used to stabilize moods. Many children with autism may have seizure disorders and it is very important that these medications are carefully monitored and managed.
ANTI-ANXIETY:
Benzodiazepines, including Ativan® and Klonopin® are used to address symptoms related to anxiety. Sometimes, beta blockers (such as Inderal® and Catapres®) designed to help with high blood pressure may also be effective.
STIMULANTS:
Sometimes medications prescribed for attention deficit hyperactivity disorders, such as Ritalin®, Concerta®, and Adderall®, are used.
References:
Aman, M., Rettiganti, M., Nagaraja, H. N., Hollway, J. A., McCracken, J., McDougle, C. J., ... & Posey, D. J. (2015). Tolerability, safety, and benefits of risperidone in children and adolescents with autism: 21-month follow-up after 8-week placebo-controlled trial. Journal of child and adolescent psychopharmacology, 25(6), 482-493.
Blankenship, K., Erickson, C. A., Stigler, K. A., Posey, D. J., & McDougle, C. J. (2010). Aripiprazole for irritability associated with autistic disorder in children and adolescents aged 6–17 years. Pediatric health, 4(4), 375-381.
Coury, D. L., Anagnostou, E., Manning-Courtney, P., Reynolds, A., Cole, L., McCoy, R., ... & Perrin, J. M. (2012). Use of psychotropic medication in children and adolescents with autism spectrum disorders. Pediatrics, 130(Supplement 2), S69-S76.
Dr. Jennifer Zarcone is May Institute’s Chief Clinical Officer. Her areas of interest include the effects of pharmacological and behavioral interventions in the treatment of severe behavior disorders in individuals with autism.
About May Institute
May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis and evidence-based interventions, serving autistic individuals and individuals with other developmental disabilities, brain injury, neurobehavioral disorders, and other special needs. Founded nearly 70 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. May Institute operates five schools for children and adolescents with autism spectrum disorder (ASD) and other developmental disabilities, including one in Randolph, Mass. For more information, call 800.778.7601 or visit www.mayinstitute.org.
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