The various topics covered in this overview paper for parents of young autistic children represent, for the most part, a consensus of the views, based on research and personal experience, of all four authors. However, the authors differ in their opinions on the role psychoactive drugs should play. We will present you with the conflicting opinions, so you can decide for yourself.
Grandin has a relatively accepting position on the use of psychiatric medications in autistic children. She feels that it is worthwhile to consider drugs as a viable and useful treatment. Rimland and Edelson, on the other hand, are strongly opposed to the use of drugs except as a possible last resort, etc. – They feel the risks are great and consistently outweigh the benefits. Adams has an intermediate view.
There are no psychiatric medications for “autism,” but there are many psychiatric medications used for treating specific symptoms often found in autism, such as aggression, self-injury, anxiety, depression, obsessive/compulsive disorders, and attention deficit/hyperactivity disorder (ADHD). These medications generally function by altering the level of neurotransmitters (chemical messengers) in the brain. There is no medical test to determine if a particular medication is called for; the decision is based on the psychiatrist’s evaluation of the patient’s symptoms. This is a “trial and error” approach, as dosages need to be adjusted differently for each person, and one medication may be ineffective or have negative effects while others are helpful.
For some classes of drugs the doses which are successful for reducing symptoms, such as aggression or anxiety, are much lower for those with autism than for normal people. For the SSRI drugs, such as Prozac (Fluoxetine), Zoloft (Sertraline), and other antidepressants, the best dose may be only one-third of the normal starting dose. Too high a dose may cause agitation or insomnia. If agitation occurs, the dose must be lowered. The low-dose principle also applies to all drugs in the atypical or third generation antipsychotic drug class, such as Risperdal (Risperidone). The effective dose will vary greatly between individuals. Start low and use the lowest effective dose. Other classes of drug, such as anticonvulsants, will usually require the same doses that are effective in normal individuals.
Antidepressant drugs such as Prozac or Lexapro often work best for anxiety and panic attacks. Antidepressants stopped my constant panic attacks and my colitis cleared up and stopped. I have been taking a low dose of desipramine, an old tricyclic, for over 30 years. The medication stopped debilitating panic attacks. The atypical antipsychotics have much more serious side effects than antidepressants. Medications such as Risperdal and Abilitfy should be reserved for severe aggression problems in older children and adults. They should not be given to young children as sleep aids or to reduce hyperactivity. The side effects of the atypical antipsychotic class of drugs are high weight gain, diabetes, and tardive dyskinesia (movement disorder). For more information consult the 2nd edition of Grandin’s book, “The Way I See It.”
Psychiatric medications are widely used to treat the symptoms of autism, and they can be beneficial to many older children and adults. However, there are concerns over their use. There is relatively little research on their use for children with autism. There are almost no studies on the long-term effects of their use, especially for the newer medications, and there is a concern that their long-term use in children may affect their development. They treat the symptoms, but not the underlying medical causes of autism. One must balance risk versus benefit. A drug should have an obvious positive effect to make it work the risk. In order to observe the effect of a drug, do not start a drug at the same time as you start some other treatment. There are far too many powerful drugs given to young children for trivial reasons. In young children, special diets, vitamins, and fish oil supplements should be tried first.