Medication Interventions
Medication is prescribed for specific symptom management. Baseline symptom data collection is necessary before medication is started and targets need to be chosen so potential benefits can be documented. The use of medication in a child or young adult with an ASD is done in conjunction with social, environmental and educational accommodations as well as behavioral strategies. This combined approach is essential for the best outcome. Although medications have been used with variable success for many years there are no long term controlled studies involving large numbers of children. The decision to begin, stop or continue medication is is made during a collaboration between parents and the specialist prescribing the medication. Emphasis is given to associated medical conditions or mental health disturbances that also require medication.
The collaborative process to decide on medication is based on an assessment of the risks and benefits. The opinion and preferences of caregivers in both home , out of home and school settings must be considered but the final decision is always from the parents. Environmental accommodations that could increase or complement medication success should also be pursued.
Every medication has potential side effects.These must be discussed openly and monitoring options must be identified and agreed upon. Duration of therapy, dosage and treatment schedules must also be determined. At all times the focus must be on how success or failure will be measured and what the trial period will be. Doctors with appropriate training and experience in the use of medication in ASDs should lead this process.
The most common prescribed medication is a methyphenidate preparation. These include ritalin, Concerta, Metadate CD, Daytrana, and Focalin. These product have different durations and peak level profiles and some must be swallowed without chewing. These medication reduce motor restlessness and hyperactivity and increase attention. Another stimulant medication called Adderal is also used but information on response is less extensive and there is some experts believe there is a higher rate of side effects including irritability, mood lability and sleep disturbance. A test dose should always be used and toleration monitored in terms of side effects. Children with ASDs are more prone to the above described side effects then children with ADHD who are treated with stimulant medication.
Risperidol (Risperidone) is another commonly prescribed medication. Benefits include a decrease in irritability, aggression and self injurious behaviors. It can be especially beneficial for children with severe tantrums or self injurious behaviors (SIB). Repetitive behaviors including stereotyped behaviors(stereotypies) are also frequently reduced. It does not increase appropriate social behaviors but it does often decrease inappropriate social behaviors and provides the opportunity for traditional behavioral strategies to substitute a new appropriate behavior. The most common side effects are tiredness, increased appetite and weight gain. There appear to be no significant liver effects.
Melatonin is often used to improve sleep pattern in children with ASDs by decreasing sleep latency (SL). It is well tolerated and is given 1 hour before bedtime. It comes in a rapid dissolving pill form and can be purchased without a prescription. Baseline sleep data in terms of when your child is placed in bed, when they fall asleep and when they wake during the night or in the morning should be obtained prior to beginning the medication. Behavioral strategies and sleep cuing techniques should always be used first before medication is tried or in conjunction with the medication depending on the severity of the sleep disturbance.
Serotonin re: uptake inhibitor medications have also been used if symptoms of anxiety, mood or other repetitive patterns including obsessive-compulsive symptoms warranted their trial. In these situations an associated mental health problem (co morbid) is being treated. As a parent be cautious about observational reports of benefits from medication. Strong evidence based research is often limited for the use of medications in ASDs.
