Drugging Autistic Children

There is a popular sentiment today that autistic children are inappropriately medicated. This claim is commonly made to promote an alternative therapy, or sometimes in the rant of an autism denier who would have us believe autism is simply a combination of bratty children and poor parenting skills.

"Available drug therapies at best only alleviate some of the symptoms, and sometimes cause undesirable side-effects," says the Alternative Medicine Foundation in its discussion of autism treatment. It draws attention away from medically recommended behaviour-based treatments by calling them "promising," but then emphasizing their intensive nature and the long time span involved. "Parents of young or newly-diagnosed children with autism often feel there is no time to wait for the science to prove the effectiveness of a particular treatment."

The Foundation paints a picture of desperate parents who are racing against time and who turn to alternative medicine. It fails to mention that evidence in favour of behavioural therapies far outweighs any research supporting treatments such as chelation, hyperbaric oxygen therapy, special diets, nutritional supplements or cranio-sacral therapy. Additionally, there is no recognition that some of the so-called alternative therapies it lists, for example music and sensory integration therapy, are often found in mainstream treatment programs.

Medication does not treat autism

There is currently no medication available to treat or cure autism. Doctors can prescribe drugs to treat some of the most severe symptoms, so autistic children can benefit from education and from the behaviour-based therapies, but it is important not to think of such drugs as the primary treatment mode. Drugs prescribed by medical doctors or psychiatrists are not intended to treat autism, but they can make the real treatment possible.

Drugging autistic children: What the medications are for

The American Academy of Pediatrics (AAP) recognizes behavioural therapy and education of people with an autism spectrum disorder as the "cornerstones of management of ASDs. These interventions address communication, social skills, daily-living skills, play and leisure skills, academic achievement, and maladaptive behaviors." The Academy never mentions drugs as a primary mode of treatment for autism.

An AAP report on management of autism discusses the specific medical needs of autistic children and adolescents. Some of the medical conditions that tend to occur together with autism are epilepsy and gastrointestinal problems. Up to 39 percent of autistic children also have a seizure disorder; up to 70 percent have digestive tract symptoms, "including abnormal stool pattern, frequent constipation, frequent vomiting, and frequent abdominal pain," at some point in their lives. It is not uncommon to treat these with prescription drugs, but again these medicines should not be seen as treatments for autism. They are intended to relieve symptoms associated with separate medical condition, and not to cure or treat autism in any way.

Drugging autistic children: Psychiatric conditions & challenging behaviours

There are two main reasons prescribe psychotropic medications to autistic children: to treat an additional psychiatric disorder, or to treat challenging behaviours that are severe enough to create a major disruption at home and school, and in the therapeutic setting.

Some psychiatric conditions that occur with autism are: phobias, anxiety and major depression; obsessive compulsive disorder (OCD); attention deficit hyperactivity disorder (ADHD); and, bipolar disorder. Autistic children or teens may also be given medications because of extremely challenging behaviour, including violent outbursts or self-injury.

Drugging autistic children: Perception vs. reality

Contrary to what we may believe, research shows that at least 55 percent of autistic children and teens in the United States are not receiving any kind of psychiatric medication. Considering the high percentages of young people who also have at least one psychiatric disorder in addition to being autistic - 44 percent for specific phobias, 37 percent for OCD, at least 32 percent for ADHD and up to 24 percent for depression - it seems reasonable to see a significant number receiving psychotropic medication.

Those of us who have concerns about medicating children, often focus on such issues as side effects. It is common to hear people worrying aloud about children seeming sleepy, acting like zombies, or maybe acting out. These behaviours are easily attributed to the drugs a child takes even though the casual observer may not be familiar with the details of the child's diagnosis or medications, and may not have any idea how the child behaved before starting medication. It is true that some of the psychiatric medications can cause behavioural changes, but so can some drugs prescribed for seizures or digestive problems. And of course, when we discuss autism we are dealing with a pervasive developmental disorder with major behavioural components. The observer who believes an autistic child to be inappropriately medicated may simply be observing symptoms of the autism itself.

Drugging autistic children: Prescription guidelines

The AAP report on autism includes guidelines doctors should use in prescribing medications for psychiatric conditions and challenging behaviours. These guidelines require doctors to explore non-drug alternatives, to weigh risks against benefits of a drug with the family, and to conduct both baseline and follow-up investigations that allow the doctor to evaluate how well the medication is working.

Being the parent of a disabled child is a tough job, regardless of the disability. Parents of children with an autism spectrum disorder often face the additional challenge of being judged by people who think our children are badly behaved or that we are negligent or ineffective parents. Even well-meaning friends can sometimes make assumptions about our kids without realizing that's all they are. It's easy to judge the parent of an autistic child for giving them medications, when a wholesome diet or a more structured environment sounds like a good idea to you.

If it seems to you that most or all autistic kids are medicated, and that these drugs are unnecessary, you may want to think again. The statistics show this is not true. Whether or not to try medication is a decision to be made by each family, in consultation with their doctor and taking account of the child's unique needs. No medication should be prescribed lightly, but by the same token no casual observer's uninformed opinion about children's medications in general should prevent a family from obtaining medications that are needed for medical or psychiatric conditions.

Sources:

"Anticonvulsant medications." Epilepsy Canada

"Autism Spectrum Disorders: An alternative and complementary medicine resource guide." Alternative Medicine Foundation

Ovsanna T. Leyfer, "Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders." Journal of Autism and Developmental Disorders

"Metoclopramide." Medline Plus (National Library of Medicine, National Institutes of Medicine)

Scott M. Myers, Chris Plauché Johnson and the Council on Children With Disabilities, "Management of Children With Autism Spectrum Disorders." Pediatrics