While the first clinical account of autism spectrum disorder (ASD) was published more than 75 years ago by child psychiatrist Leo Kanner, the precise cause of autism is still not clear to scientists. Billions of dollars have been spent on autism research over the years in an attempt to unravel the mystery that now affects tens of millions of people worldwide and search for autism medication.
While scientists continue to search for answers, many individuals on the spectrum, both children and adults, have found relief from troubling symptoms with the help of medications. Temple Grandin, a renowned professor of animal science, inventor, and autism advocate speaks of her experience with medication saying, “I would not be here now if I did not have anti-depressants.”
She does recognize that medication is not for everyone and states, “If you start using a medication in a person with autism, you should see an obvious improvement in behavior in a short period of time. If you do not see obvious improvement, they probably should not be taking the stuff. It is that simple.” Grandin is not a medical doctor, but her personal experience with autism medication resonates with many individuals on the spectrum and their families.
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AUTISM MEDICATION: TREATING AUTISM AND ITS CORE SYMPTOMS
Associated medical concerns for autism
People with ASD are often diagnosed with co-occurring conditions. These conditions are separate issues from ASD, but often present similarly making them hard to diagnose. If you suspect your child may be struggling to manage an additional condition, it is vital to seek a diagnosis. Once the co-occurring condition is identified, doctors, therapists, and your child’s school can begin offering services to help your child manage symptoms.
Some of the most common co-occurring conditions people with autism experience are anxiety, depression, obsessive-compulsive disorder, seizure disorders, bipolar disorder, and gastrointestinal disease. A combination of therapy and medicine is typically used to treat these conditions.
Can autism be treated with medication?
Specific symptoms that affect an individual’s ability to function optimally can sometimes be treated with medication. The Interactive Autism Network and Kennedy Krieger Institute states “No medication is currently approved to treat the core symptoms of autism. However, a number of medications are prescribed to treat other conditions and symptoms often found in children and adults with autism, such as attention-deficit hyperactivity disorder, anxiety disorder, self-injury, aggression, and seizure disorders.” (“Medications,” 2016).
Medications used to treat symptoms of autism are sometimes used “off-label” meaning that the medications were not originally developed to be used to treat symptoms of autism, but enough tests and research make them an appropriate option to try. Other medications are developed to treat symptoms that might co-occur with a variety of disorders such as anxiety or mood fluctuations.
What are the treatments for autism?
Some of the most common types of medications offered to children with autism are antipsychotic drugs, stimulants, antidepressants, mood stabilizers, anticonvulsants, anti-anxiety drugs, and gastrointestinal agents.
Antipsychotic autism medication
Antipsychotic autism medications are typically used to treat the symptoms of psychosis including delusions, hallucinations, and paranoia. These symptoms are often present in conditions such as bipolar disorder and schizophrenia. Two antipsychotic medications called Risperdal (risperidone), and Abilify (aripiprazole), have both been approved by the Food and Drug Administration (FDA) for use in children with autism. Antipsychotics work by, “blocking dopamine receptors in the brain. Dopamine receptors are involved in movement, cognition, and mood. Risperidone may also affect other chemical pathways in the brain such as serotonin (also related to behavior and mood) which is known to be abnormal in some individuals with ASD.” (“Medications,” 2016).
The Eunice Kennedy Shriver National Institute of Child Health and Human Development says that “ The antipsychotic drug risperidone is approved for reducing irritability in 5-to-16-year-olds with autism. These medications can decrease hyperactivity, reduce stereotyped behaviors, and minimize withdrawal and aggression among people with autism.” (“Medication Treatment for Autism,” 2017)
Stimulant autism medication
Stimulants are a class of medication most frequently given to children with attention deficit hyperactivity disorder (ADHD). The most commonly prescribed stimulant for children with ASD and most well-studied is Ritalin (methylphenidate). Other stimulants that may be prescribed include Adderall, Concerta, Metadate CD, or Dexedrine. Stimulants are an option for some children with ASD because of the similar symptoms to ADHD including hyperactivity, poor impulse control, and inattention.
The Interactive Autism Network says, “How central nervous system stimulants work is not completely understood, but the medication is thought to target the brainstem arousal system and the cortex.” (“Medications,” 2016). The Eunice Kennedy Shriver Center also notes that “they are particularly helpful for those with mild ASD symptoms.” (“Medication Treatment for Autism,” 2017)
Depression, Obsessive-Compulsive Disorder, and Antidepressant autism medication
“Major depression is one of the more serious conditions common in people with autism, one that may be misunderstood or even missed. While sleep and behavioral problems rarely go unnoticed, depression may hide from view.” (Sarris, 2018). Depression in children with ASD is often not diagnosed until a child acts on urges to self-injure, shows aggressive behaviors, or attempts to die by suicide. Doctors at Sheppard Pratt Hospital in Maryland are seeking to find a link between ASD and depression and increase screening for depression in children on the spectrum. They encourage doctors and parents to learn the symptoms of depression in children with autism and try antidepressant medications when appropriate.
According to the International OCD Foundation, “Many behaviors associated with OCD [obsessive-compulsive disorder] such as anxiety, repetitive behaviors, and social problems are also typical of ASD. While the appearance of ASD and OCD may be similar on the surface, the processes that drive these behaviors are quite different, and each requires a different kind of treatment…It is important to determine which behaviors arise from a patient’s OCD and which arise from ASD. This has proven to be one of the major challenges in treating patients with both disorders. Other difficulties in treating patients with OCD comorbid with ASD are lack of insight, general inability to emotionally and socially connect, angry outbursts, frequent, extreme and unpredictable changes in mood, and impulsivity.” (Gorbis & Dooley).
The most commonly used types of antidepressants in autism are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). These medications were originally developed for people with depressive disorders, anxiety disorders, and obsessive-compulsive disorder. The Interactive Autism Network says that “Most antidepressants work by changing the levels of specific chemicals in the brain called neurotransmitters.” (“Medications,” 2016).
The most commonly prescribed antidepressants for ASD are Prozac, Luvox, and Celexa, but there are more than a dozen approved for use in people with ASD. SSRIs are thought to, “reduce the frequency and intensity of repetitive behaviors; decrease anxiety, irritability, tantrums, and aggressive behavior; and improve eye contact,” while TCAs achieve similar results they are more effective for some people and sometimes cause fewer side effects. (“Medication Treatment for Autism,” 2017)
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Mood stabilizing autism medication
Like antipsychotic medications, mood stabilizers also treat features of bipolar disorder and ASD including, “aggression, self-injury, impulsivity and conduct disorder.” (“Medications,” 2016). Mood stabilizers require more research to understand how they help children with autism, and much of the current evidence is anecdotal. Lithium, Lamictal, Depakene, Depakote, Tegretol, Topamax, Trileptal, and Keppra are options to explore with your child’s pediatrician.
Autism medication for anxiety, epilepsy, anticonvulsants, and gastrointestinal autism medication
Anticonvulsant medications are often used in the estimated 33 percent of children with autism who have a co-occurring seizure disorder. Gastrointestinal medications are used to treat symptoms such as acid reflux, constipation, and diarrhea that are common in children with ASD. The relationship between ASD and seizures and gastrointestinal distress is still unclear, but it can be helpful to recognize their relationship to ASD when observing your child’s behavior and managing wellbeing.
Xanax, Niravam, Buspar, Ativan, Vivitrol, Valium, melatonin, and antihistamines are commonly used to manage seizure disorders in children with ASD. (“Medications,” 2016). Many of these medications also offer anti-anxiety benefits and may help your child sleep. Gastrointestinal autism medications, like all medications, are best matched to your child with the help of a pediatric specialist.
Autism and medication side effects
Medications are not one size fits all. A medication that works wonders for a child with comparable symptoms may create more issues or be entirely ineffective for another. When you choose to try a medication, it is important to be informed on common side effects linked to that medication as well as to take note of any unusual behavior or signs of distress your child may be showing. This is particularly important if your child is nonverbal or has limited ability to communicate.
Signs of distress might include but are not limited to abnormal sleeping patterns, constipation or diarrhea, rash or hives, allergic reaction including anaphylaxis, lethargy or fatigue, or an increase in the symptom you are trying to treat. According to the Interactive Autism Network, antipsychotics are the most commonly used psychiatric drug for children with autism. “The U.S. Agency for Healthcare Research and Quality weighed the scientific evidence on those medications. It found significant benefits and also “harms,” or bad side effects. The drugs reduce challenging and repetitive behaviors when compared to no treatment. They also are associated with significant weight gain, sedation, tremors, and movement disorders, it noted.” (Sarris, 2016).
The American Academy of Child and Adolescent Psychiatry suggests closely monitoring your child’s weight if he/she is taking antipsychotic medication and doing routine blood work to check for high cholesterol or signs of diabetes or prediabetes. Ultimately, very few medications come with no side effects, but if the medication is a good fit, the intensity of side effects may taper off after the first few weeks. Maintaining an open line of clear communication with your child’s pediatrician will be imperative to make sure your child is receiving more benefit than the risk from a given medication.
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Finding the right autism medication
It is critical to work with not only your child’s pediatrician but any specialists on your child’s team to determine which medication(s) are the best fit for your child. Be sure you ask the prescribing doctor for a comprehensive list of possible side effects to look out for as well as identifying and possible interactions between medications your child is taking. You will need to give your child his/her medication on a schedule to avoid over-medicating or under-medicating your child. Also, be aware of the appropriate time frame and dosage to wean your child on and off of medication.
Your child’s pediatrician should have a doctor-on-call after hours to answer any questions you have. Once you have found a medication that you and your child’s pediatrician agree is a good choice, try not to get discouraged if the first dosage, or even the first prescription, is not the right fit for your child. Finding a medication that works well with your child’s unique body and brain chemistry can take time.
If you are comfortable with your child trying a new medication, you can ask your child’s pediatrician if he/she is eligible for a medication trial. Researchers at the University of Buffalo are studying the potential use of a cancer drug on people with ASD. The researchers think that the medication called romidepsin (currently used to treat lymphoma) could help treat children with autism who struggle with social skills. The medication is not yet being tested on humans but professor Dr. Zhen Yan is hopeful that the medication will be available soon and with minimal side effects.
Medical marijuana for autism
If you live in a part of the world where medical marijuana is legalized, you may want to explore it as an option to treat symptoms of your child’s autism. In the United States, a limited number of children have access to medical marijuana with even fewer living in areas where autism is considered a qualifying condition to use the plant medicinally. Autism Parenting Magazine previously published an article on medical marijuana for autism that referred to MAMMA, “Mothers Advocating Medical Marijuana for Autism. MAMMA is a parent advocacy group with chapters in seven US states (Arizona, Georgia, New York, Pennsylvania, Texas, Iowa, and Illinois).
MAMMA’s goal is to give all children with autism legal access to medical marijuana under the care of a physician.” (Hobbs, 2018) If you would like to advocate for medical marijuana’s legalization in your area, MAMMA offers resources on its website. The Shaare Sedek Medical Center in Jerusalem and Children’s Hospital of Philadelphia are studying the effects of medical marijuana on children with autism in hopes of making it available to any family who would like to try it.
Benefits of medical marijuana for autism
According to MAMMA, children who used medical marijuana have found relief from symptoms including seizures, self-injurious behaviors, mood dysregulation, poor sleeping patterns, and anxiety. Families of MAMMA often say that medical marijuana alleviates as many symptoms as antipsychotics and other pharmaceuticals with reduced side effects. Parents who are hesitant to try pharmaceuticals or who have a child who does not tolerate medications well with may be interested in trying a more natural option such as medical marijuana.
Can medical marijuana cure autism?
Just as pharmaceuticals cannot cure autism, neither can medical marijuana. Children, especially girls, with Asperger’s syndrome or high functioning autism who show minimal symptoms on an everyday basis might appear to function “normally” with the help of medical marijuana or other pharmaceuticals, but this statement is currently purely anecdotal. Studies on the effects of medical marijuana on autism are in the beginning phases, but researchers hope to find a strain and dosage of the plant that gives children with autism the most relief from the symptoms possible.
What are other treatments for autism?
Beyond pharmaceuticals and medical marijuana, there is a wide variety of treatments available that might help your child. Your child might work with an occupational therapist, physical therapist, psychologist, art therapist, music therapist, or participate in hippotherapy or recreational therapy. If you are unsure where to begin or what type of treatments and therapies are best for your child, consult his/her pediatrician. Together you can assess your child’s strengths and challenges as well as likes and dislikes to build a program.
Your child’s pediatrician should have a list of providers he/she recommends as well as ones that accept your insurance. Some programs offer grants and scholarships to families whose insurance does not cover their services. Additionally, you can seek community groups for your child to join as well as support groups for parents and caregivers of children with autism.
Applied Behavioral Analysis
If you have never tried Applied Behavioral Analysis (ABA), it can be a valuable therapy to use in conjunction with autism medication. It is time-tested and can be used with children at all places on the spectrum. ABA focuses on the whole child and seeks to improve social skills, communication, education, learning, self-care, motor skills, and familial relationships. It is practiced with a therapist, but families must commit to continuing the program at home between sessions.
ABA is usually practiced upwards of 20 hours a week and meetings can take place in a therapist’s office, at school, at home, or with other members of your child’s team. The more people who are on board with the therapy, the better.
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AUTISM MEDICATION: TREATING AUTISM AND ITS CORE SYMPTOMS
Consistency is key
Neurotypical children and their peers with autism thrive on routine and rhythm. Whether you decide to try pharmaceutical, medical marijuana, ABA, or a combination of the three, it is critical to maintaining a routine for your child. Medications need to be taken consistently for a child to receive full benefits, and as mentioned above, ABA requires a time commitment not only from your child’s therapist but as many people in his/her life as possible. If you are having trouble finding a treatment that works for your child, or suspect he/she is experiencing adverse effects from medication, reach out to a pediatrician for advice. In the event of an extreme reaction, contact emergency services immediately.
Gorbis, E., & Dooley, L., B.A. (n.d.). Treatments for Obsessive-Compulsive Disorder comorbid with Autism Spectrum Disorder. Retrieved October 2018, from https://iocdf.org/expert-opinions/treatments-for-obsessive-compulsive-disorder-comorbid-with-autism-spectrum-disorder/
Grandin, T. (2015). The Way I See It – A Personal Look at Autism and Aspergers. Future Horizons Incorporated.
Hobbs, K. G. (2018, June 21). Benefits of Medical Marijuana and Autism to Be Studied. Retrieved October 2018, from https://www.autismparentingmagazine.com/benefits-medical-marijuana-autism-studied/
Medications. (2016, December 13). Retrieved October 2018, from https://iancommunity.org/cs/what_do_we_know/medication
Published by the Interactive Autism Network
Medication Treatment for Autism. (2017, January 31). Retrieved October 2018, from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment
Current Owner: Office of Communications at the Eunice Kennedy Shriver National Institute of Child Health and Human Development
Sarris, M. (2018, March 14). Diagnosing Depression in Autism. Retrieved October 2018, from https://iancommunity.org/diagnosing-depression-autism
Sarris, M. (2016, December 13). Antipsychotics and Autism: Weighing the Benefits, Eyeing the Risks. Retrieved October 2018, from https://iancommunity.org/ssc/antipsychotics-and-autism-weighing-benefits-eyeing-risks