Abstract | Summary | Original Article

How Do I Decide if my Child Should Have Medication?

Some children, teenagers, and adults with autism behave aggressively towards others, or hurt themselves. This almost always occurs because of stress, frustration, anxiety, or non-compliance.  These behaviours often arise because they cannot tell other people how they feel or what is happening to them. In the past few years, medications have been studied to see if they can stop or reduce this kind of behavior. Some parents don’t want to give their children drugs because they fear possible side effects. They may wonder if it is better to use behavior therapy first. 

The first questions parents and other caregivers should ask are:
Is the acting out behavior causing severe problems for the person with ASD and/or others?
Has it been going on for a long time?

If the behavior happens only sometimes or is of recent onset and is not a serious threat to self or others, then taking daily medication may not be the answer.  One reason is that if the behavior occurs only occasionally, it is difficult to know if the medication is realy needed. The behavior may go away by itself, and so it will be difficult to know if the medication is really working. With effective, but powerful drugs, it is best to use them only if it is really clear that they are working.

If the behavior is uncontrollable, of longer duration, and the safety of self or others is a serious concern, then the person with ASD may be better taking medication. However, a careful exam should be done by a doctor who can help parents or other caregivers decide, with the person with ASD when possible,  whether or not to use medication.  He/she will want to know what has been tried in the past and what is being done now to help control or stop the behavior. If it has started recently, there could be a physical problem that others may not know notice (the author uses the example of an abscessed tooth). It may be that a change at home or school is making the person with ASD nervous or frightened. In that case, then behavioural treatments might help the person cope with the change wthout the need of medication. The other response may be that whatever is bothering the person with ASD, itself, needs to be changed.

Drugs like risperidone are very effective but should be used only for those whose tantrums, aggression, or self-injury has not responded to anything else. 

Both medication and behavior therapy used together can successfully help those young people and adults who have severe behavior problems.

If medication is used, it should only be usef for a limited time period, if that is possible. There is a feeling that medications are often prescribed even though the need for them has decreased. In thata case, a trial off medication is warranted.

Finally, if medication is used, then the doctor should closely monitor for side effects.

Adapted from: How do I decide whether or not to use medication for my child with autism? Should I try behavior therapy first? Lawrence Scahill.  Journal of Autism and Developmental Disorders. 2008; 38: 1197-1198.