Medications and autism spectrum disorders

When to consider medications for children with ASD

Making decisions about if and when to try medications can be difficult. You need to weigh up the benefits against the possible risks.

For example, some parents might consider talking to their doctor about medications if safety is an issue – if their child is harming himself or others. Other parents might consider medications if a characteristic or condition is very severe or hasn’t responded to other approaches.

Who to talk to about medications

Medications that affect children’s minds or how they’re feeling are usually prescribed by a paediatrician or child and adolescent psychiatrist. Sometimes a GP might also prescribe these medications. When choosing a doctor, look for one who has experience working with children with ASD.

Common ASD characteristics

Children with ASD might show a range of characteristics, and these characteristics vary between children. They can also change depending on the child’s age and stage of development.

Some of these characteristics are:

• hyperactive behaviour – when children find it hard to sit still and are always on the go
• anxiety – when children worry too much or are afraid of things
• obsessive or repetitive behaviour – when children do something over and over again
• tics – when children have jerky movements they can’t control, such as blinking, twitching their faces, or jerky movements of the arm or shoulder
• aggressive behaviour – the challenges of ASD can lead to high emotion
• trouble sleeping
• seizures.

Medication might be prescribed to help with some of these characteristics. The medication your doctor suggests will depend on which behaviours or responses are causing your child the most trouble and how severe these are.

Medications and side effects

Before deciding whether medication is right for your child, it’s important to understand what the medication does and what its side effects are. Here we explain the medications that might be prescribed for the characteristics above. We’ll also go over the most common side effects of these medications.

Hyperactive behaviour
Ritalin and Concerta are prescribed to help children with Attention Deficit Hyperactivity Disorder (ADHD). Research and testing shows that they can also cut down hyperactive behaviour in some children with ASD. This might allow children to concentrate on a task for longer, and think more before they act.

The main side effect of these medications is lower appetite. This can mean that children using them might not gain enough weight, or might even lose weight.

Other possible side effects include:

• tics
• more repetitive behaviours
• increased anxiety
• increased hyperactive behaviour.

Anxiety and obsessional behaviour
Selective serotonin re-uptake inhibitors (SSRIs) can help lower anxiety, which we often see in children with ASD. These medications can also lower children’s obsessional behaviour.

The most common side effects of SSRIs are:

• tummy troubles (sick feelings and tummy pain)
• trouble sleeping
• irritable or nervous feelings.

Teenagers and grown-ups can experience sexual dysfunction with SSRIs.

Recently doctors and scientists have started to worry that people taking SSRIs might think about hurting or even killing themselves, particularly if they are younger than 25. If these feelings happen, it is almost always within the first couple of weeks of starting the medication, so you need to watch children carefully during this time.

Tics
Children with ASD often have tics. Tics are jerky movements that happen over and over again, which children can’t really control. Tics usually happen in children’s faces or shoulders. Sometimes children will also grunt or clear their throats.

In some children, tics happen a lot and make them uncomfortable. If this is happening to your child, you might think about medication.

Several different medications can help cut down tics. These medications include antipsychotics and Clonidine. Clonidine can also help lower hyperactive behaviour.

The side effects of antipsychotics include:

• gaining weight
• drooling
• feeling tired or sleepy.

Clonidine can make children feel very sleepy. In some children, it can cause a drop in blood pressure or heart rate. It’s also very dangerous if too much is taken, so the tablets need to be stored carefully.

Aggressive behaviour
Children with ASD can behave very aggressively towards other people. Sometimes they break or damage things as well. Some children also hurt themselves by hitting or head-banging.

The medication Risperidone can be prescribed to help reduce these behaviours. It belongs to a group of medications called atypical antipsychotics.

The atypical antipsychotics can cause serious side effects in some children. The most common are:

• weight gain, which can sometimes be quite noticeable
• feeling sleepy or tired
• drooling.

Less common side effects include:

• stiff arms or legs, or jerky movements children can’t control
• changes in a hormone called prolactin, which can cause breast development and milk secretion
• changes in how children’s livers are working, how many fats they have in their bodies, and how their bodies control blood sugar levels.

Trouble sleeping
Many children with ASD either have trouble falling asleep or wake up often during the night.

The hormone melatonin makes us sleepy. It’s normally produced after it gets dark at night, and is made by a small gland in the brain called the pineal gland. Doctors can prescribe melatonin as a medication to assist people in falling asleep.

Children might feel sick or get headaches when they take melatonin, particularly if they have been taking it for a while. Some adults say they feel ‘hung over’ the next day after taking melatonin.

Read more about dealing with sleep difficulties in children with ASD.

Seizures
Up to one-third of people with ASD have seizures at some stage in their lives. Some people with ASD have a lot of seizures.

This problem can usually be treated effectively with one of the anti-epilepsy medications. There are many different anti-epilepsy medications, so the choice of the best one depends on the type of seizures. It will also depend on any other problems children have or other medications they’re taking.

Side effects vary with different anti-epilepsy medications. Common side effects include feeling sleepy, behaviour changes and tummy troubles. Your doctor should give you information on the side effects that might occur with the particular medication your child is taking.

Assessing whether a medication works

Once your child starts taking a new medication, he’ll need to be monitored carefully by you and your doctor.

It can also help for you to get a good understanding of the targeted behaviour or problem before your child starts the medication. Take a week to write down details like when, how often and how long it occurs, and think about how intense it is. Also pay attention to your child’s sleeping habits and appetite. You’ll then be in a good position to notice whether anything is changing once your child starts the medication.

When your child starts taking a medication, try not to change anything else about her routine or therapy program. Then if you notice any changes, it’ll be easier to tell if they have been caused by the medication.

Another idea is to see whether a family friend or neighbour – someone who doesn’t know your child has started taking medication – notices any difference in your child’s behaviour. If this person says something to you about your child’s behaviour improving, it can be a good indication the medication is having some positive effects. 

Other things to consider and discuss with your doctor

• Every child with ASD is different, so it can take a few tries and visits to the doctor to find a medication and dose that works for your child.
• Often a medication needs to be taken in a certain way to be effective. Talk to your doctor about when and how often your child needs to take it, and whether it should be with or without food.
• Don’t stop a medication suddenly, especially if your child has been taking it for a long time. Talk to your doctor about stopping a medication.
• Most medications were originally designed for adults, so their effects on children are not always known.

• Rated1 ratingsRate this item
• FeedbackTell us what you think of this item
• Your story Share your parenting tips