BIOMEDICAL INTERVENTIONS - MEDICATIONS

Despite claims of miracle cures, there are no medications that have been proved to be a 'cure' for Autism Spectrum Disorders to date. However, there are cases where medication can play a role in reducing the symptoms of comorbid disorders or behavioral issues, particularly if these symptoms have been interfering with the effectiveness of other interventions and schooling. Examples of these situations include:

• Attention Deficit Disorder

• Seizures and epilepsy

• Obsessive Compulsive Behavior

• Self-injurious behavior

• Depression

• Sleep disorders

• Anxiety.

Parents and the medical community are wise in being very cautious to recommend medications for children while they are still physically and cognitively developing. Parents have pointed out that whilst a subset of children have been found to have co-morbid mood, anxiety and compulsive disorders, autistic people are not necessarily psychotic, particularly anxious, depressed or have bipolar disorder. Medications should only be used when the benefits significantly outweigh the risks involved.

It should be noted that in some cases, parents have found drug therapy very helpful when all other interventions have failed to solve a particular issue. In particular, comorbid disorders such as ADHD and Bipolar disorder have often responded well to certain medications. Doctors are generally aware of the need to minimize the amount of medication in a child's life and parents should research this area thoroughly before making decisions about biomedical interventions.

Although most medications undergo rigorous research to qualify as evidence-based treatment, their use in the context of Autism Spectrum Disorders and/or children still requires much more research in the majority of cases. The younger a child is, the greater the risks of using medications for an immature nervous system so the benefits of the drug must be very high for younger children, such as preventing extreme self-injury when other interventions have not worked.

hyperactivity and lack of attention

The most frequently prescribed medications for ADHD are stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. Because many of the medications used to treat ADHD are powerful stimulants with a potential for abuse, there is controversy surrounding prescribing these drugs for children and adolescents. However, research on ADHD sufferers who either receive treatment with stimulants or go untreated has indicated that those treated with stimulants are in fact much less likely to abuse any substance than ADHD sufferers who are not treated with stimulants.

Close monitoring is required for a child's response to stimulants. One study found that a third of children on the autism spectrum actually had increased hyperactivity, dysphoria, stereotypies or motor tics (Di Martine, Melis, & Cianchetti 2004).

seizures and epilepsy

Seizures occur in about a quarter of children with an Autism Spectrum Disorder. There is no cure but anticonvulsant medications are the most common treatment. Medications used include valproic acid, lamotrigine, topiramate, and carbamazepine. The dosage of the medication is adjusted so that the least possible amount of medication will be used to be effective.

A medication must be taken when specified to maintain a constant level in the blood. A regular blood test is usually done to measure the amount of drug in the blood stream. Too much may have side effects such as dizziness or an upset stomach. Too low and there may be a risk of seizures. Parents should keep track of the frequency of their child's seizures and notify the doctor or nurse of medication side effects in case the medication needs adjusting.

Medications and behavioral issues

In some cases, behavioral management programs may be supported by medications to reduce tantrums, aggression or self-injuring behavior. The medications used are those that have been developed to treat similar symptoms in other disorders. Anti-psychotic medications have been used for severe behavioral problems, as they reduce activity of dopamine in the brain. Typical anti-psychotics like chlorpromazine, haloperidol, thioridazine and fluphenazine have been tested and found useful in managing extreme behavioral problems. However, further research is needed in their use by children and adolescents and there are possible side effects associated with each medication.

depression, anxiety and obsessive compulsive disorder

Selective serotonin reuptake inhibitors, or SSRI’s, are commonly prescribed for adults with depression or anxiety disorders. In autistic children, these have been shown to lower the rates of repetitive behavior and increase social interaction and eye contact. However, further research is needed in this area as the effects of some SSRIs on young children are still not fully explored.

research on anti-psychotics

Although no medication acts a 'cure' for Autism Spectrum Disorders, typical and atypical anti-psychotics have proved to be the most effective medication for reducing the overall symptoms to date. Their use in not wide spread due to side-effects, particularly with long-term use.

Typical anti-psychotics such as haloperidol, fluphenazine, and thioridazine, were actually developed to treat schizophrenia. They help to manage symptoms of Autism Spectrum Disorders but possible side effects include stiffness, restlessness and involuntary movements. Long-term use can result in permanent tardive dyskinesia (Sikich 2001).

Atypical anti-psychotics include risperidone, clozapine, ziprasidone, olanzapine and quetiapine, and were developed to minimize the side effects of typical anti-psychotics. Research on risperidone has been conducted with adults who have Autism, and symptoms such as repetitive behaviors, aggression, irritability and anxiety were reduced. No changes in language or social behaviors were noted and side effects included drowsiness, weight gain, dizziness, increased heart rate and blood pressure, fatigue and drooling (McCracken, McGough & Shah 2002).

Another study found similar outcomes for ziprasodone, quetiapine and olanzapine ((King & Bostic 2006). A study on aripiprazole found similar to outcomes but with less chance of substantial weight gain in children on the autism spectrum ((Stigler, Posey, & McDougle 2004). As with most interventions for Autism Spectrum Disorders, much more research is needed to accurately establish these medications as evidence-based treatments.

basic principles for medication as an Autism intervention

If you decide to allow medication for your child, it can pay to not tell others. For example, a teacher may notice an improvement in behavior without being influenced by knowledge of the medication being used. Other interventions should not be changed at this time, so that you can tell if changes are due to the medication.

Medications should be introduced carefully, as the nervous system in many people with Autism is very sensitive and only a low dose of medication may be needed. Medication trials should always start with the lowest possible dose, with gradual increases until its effectiveness is established. The timing of medication is very important so parents must have a clear understanding of when it should be taken.

It can be useful to keep a diary of your child's response to medication, especially if several medications are prescribed. Don't stop medications abruptly, particularly if they have been taken for a long time. Always check with your doctor on the best way to discontinue a prescribed medication if its benefits do not outweigh its risks.

A 'baseline' should be set before using medication. These means getting an accurate idea of symptoms so that you can assess how well the medication is working e.g. how often is the child having seizures, or violent outbursts, or how many hours sleep each night. Where possible, this should be written down before, during, and after using a medication trial.

A child with Autism or Asperger's syndrome may not respond in the same way to medications as other children. Ideally parents should work with a doctor who has experience with Autism Spectrum Disorders.

Learn about the possible side effects of the medication and monitor your child closely for their signs.

autistic adults and medication

Many autistic adults themselves are against the over prescription of neuroleptic drugs in autistic people to control behavior. Others with co-morbid disorders have been relieved to have medication to manage these problems. Some psychiatrists are just now beginning to explore minimal doses of medication for autistic children. People against the use of Neuroleptic medications for people with Autism have formed an organization called Autistic People Against Neuroleptic Abuse.

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This autism fact sheet is licensed under the GNU Free Documentation. It is derivative of an Autism and Asperger's syndrome-related articles at http://en.wikipedia.org