1) Is there a particular medication or medications to treat autism (to address the core deficits of autism)?
No, currently there is no medication that treats the core deficits or characteristics of autism spectrum disorder (ASD), (such as speech delays, poor social skills, repetitive behaviors). Medication is aimed at reducing associated symptoms (such as hyperactivity, impulsivity, inattention, anxiety, depression, irritability, tantrums, aggression, self-injury) that interfere with functioning.
2) How is the decision made to try medication?
The decision to try medication should be made carefully and involve thorough discussion and assessment. The first step is to identify the target symptoms and determine their impact on daily functioning. If the symptom/behavior is new, it is important to first rule out a medical cause for the behavior (such as illness, headache, constipation, reflux, toothache, sleep disturbance, etc) and/or environmental factor (transition in the home, something out of the routine, etc). It is also important to differentiate psychiatric symptoms (such as anxiety, depression, hyperactivity, self-injury), from those of ASD (poor eye contact, social difficulties/withdrawal, repetitive behaviors/movements).
3) Is a child ever too young to try medication?
Medications that are approved by the FDA (Food and Drug Administration) do provide guidelines for age. Often, though, there are medications used in clinical practice that are not approved by the FDA for use in children or adolescents and thus used “off label”. So this is often the case when prescribing to young children and it becomes very important to consider carefully the medical necessity of prescribing to a young child. Also, it is important to point out that medication is not a first line intervention. The focus for any age child that is exhibiting challenging behaviors should be on ensuring that appropriate therapies and interventions are in place, and this is extremely important for younger children that have not yet been involved in interventions or just recently started intervention services. For example, children that have difficulty communicating may exhibit tantrums and aggressive behaviors as a way of communicating. Therefore, it would be important that they are receiving therapy to support more effective communication strategies.
4) If parents have other treatments in place and begin a medication trial, how do they know if the medication is working or not?
It is our recommendation that medication only be used together with other interventions (e.g., school based services, speech/behavior/occupational therapy, etc). So it is possible that it will be tricky to assess for whether the medication is working versus another intervention versus the combination of both. Some principles that prescribers of medication often follow include documenting baseline severity of symptoms and impact on functioning before a new medication is started and introducing only one medication at a time. Sometimes it can be very useful to collect baseline information using standardized behavior rating forms. These can then be repeated periodically during treatment in order to more objectively track a change in a specific symptom.
5) If a child has been taking the same medication for years and parents wonder if it is still working, is there any benefit to “taking a medication holiday”?
This is a question that definitely warrants a lot of thought and discussion with parents about the possible pros and cons of discontinuing a medication. Many of the medications we use require a slow reduction over a period of time in the dose before discontinuing. There is also the need to consider the timing of when to try a child off a medication and what factors might impact the success or failure of the “medication holiday”. For example, I have had parents request to take away a medication over the summer that has been indicated in the past to help with school related anxiety. Things I might ask or mention when considering this would include whether or not the absence of anxiety during the summer when there may be fewer demands in place would give us useful information about whether the medication was still necessary. Other considerations would be the possible long-term risks versus benefits of continuing on a particular medication. In the end, though, I think the simple answer to this question is yes, as it demonstrates that the parent has questions and initiates these very important discussions.
6) Are all medication doses based on a child’s weight/age?
No. While there are some that have guidelines for weight based dosing, many medications have just a dosing range. Whatever the case, though, I often counsel parents on the importance of focusing on achieving management of symptoms and tolerance to side effects. When I’m asked the question about whether a dose should be increased to account for growth or weight gain, I bring the discussion back to inquiring about whether there are any signs or symptoms to suggest a loss of effect to the medication, which may then necessitate a dosing change.
7) Why do you think many parents are hesitant to try medication for their child?
There is very little research on the use of medications in children. It is the case that we are explaining to parents that we don’t know the long-term effects of many of the medications we use, and we are also telling them about possible risks associated with taking specific medications. This should cause hesitation. I also think, though, that some parents feel there is more they could be doing at home and at school to support their child and medication should be a “last resort”. As was mentioned earlier, it is our recommendation that medication always be used together with other interventions, and what we find for some is that bringing a medication into the treatment plan can assist with the progress and success of other interventions.
8) What guidance do you offer parents who are afraid to try medication but feel they have exhausted all other options?
I would encourage them to have a consultation with a health care provider in order to gather more information about what medications might be considered, what benefits could come from using medicine, and what risks are associated with a specific medication.
9) Providers sometimes inquire about a parent or sibling’s use of any medication when considering options for their child with autism. Why do they do that?
Since the child with autism shares some of the same genetic make-up as the parent and the sibling, knowing what has worked or not worked for another person in the family can assist with decision making about what medication to consider trying first or possibly what to avoid.