About medications for children with autism spectrum disorder

Medication is not a ‘cure’ for autism spectrum disorder (ASD). There’s  no medication that has been proven to address the core characteristics  children with ASD show in the areas of communication and social  relations.

But for some children, medication can help with challenging  behaviour associated with ASD, which might be interfering with their  ability to learn and respond to interventions. In these cases, the appropriate medication depends on the behaviour that’s causing the most trouble and how severe the behaviour is.

Early, family-based, intensive behavioural or educational intervention works best for young children with ASD. If you and your doctor decide that a certain medication might be suitable for your child, it’s important to think of it as part of your overall intervention approach.

When to consider medications for autism spectrum disorder

Decisions about if and when to try medications can be hard. You need to weigh up the benefits for your child against the possible risks.

For example, you might consider talking to your child’s doctor about medications if your child is harming himself or others. Or you might consider medications if a characteristic or condition is very severe or hasn’t responded to other approaches.

Who to talk to about medications for your child with autism spectrum disorder

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 you’re choosing a doctor, look for one who has experience working with children with autism spectrum disorder (ASD).

Characteristics of autism spectrum disorder that medication might help with

Medication might be prescribed to help with some characteristics of autism spectrum disorder (ASD). These characteristics include:

• hyperactive behaviour or overactivity – when children find it hard to sit still, concentrate 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, like blinking or twitching their faces, or jerky movements of the arm or shoulder
• aggressive behaviour –   when children behave aggressively towards other people, break things or hurt themselves by hitting or head-banging
• sleep problems – when children have difficulty falling asleep or wake up often during the night
• seizures – when children stiffen, jerk around and become unconscious.

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 and the most common side effects of these medications.

When you and your child’s doctor talk about medications for your child, the doctor should tell you about any side effects of the medication your child is prescribed.

Hyperactive behaviour
Ritalin and Concerta are prescribed to help children with attention deficit hyperactivity disorder (ADHD). They can also reduce hyperactive behaviour in some, but not all, children with autism spectrum disorder (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:

• irritability
• tics
• more repetitive behaviour
• more anxiety
• more hyperactive behaviour.

Anxiety and obsessional behaviour
Selective serotonin re-uptake inhibitors (SSRIs) can help reduce anxiety. These medications can sometimes also reduce children’s obsessional behaviour, although more research is needed into how well these medications help with repetitive 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’re younger than 25. If these feelings happen, it’s almost always within the first couple of weeks of starting the medication, so you need to watch your child carefully during this time.

TicsSeveral different medications can help reduce tics. These medications include antipsychotics and noradrenergic agents like clonidine. Clonidine can also help lower hyperactive behaviour.

The side effects of antipsychotics include:

• gaining weight
• drooling
• feeling tired or sleepy.

The side effects of clonidine include feeling very sleepy. People might also experience low blood pressure or heart rate. Clonidine is also very dangerous if your child takes too much.

Aggressive behaviour
Risperidone can help reduce aggressive behaviour in children with ASD. It belongs to a group of medications called atypical antipsychotics.

The side effects of atypical antipsychotics include:

• gaining weight, 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
Melatonin maintains your circadian rhythm, which is your internal 24-hour clock. Your circadian rhythm helps to control when you fall asleep, how long you sleep and when you wake up.

Melatonin can help people who have trouble sleeping – for example, because of jet lag or shift work. It can also help with sleep difficulties in children with autism spectrum disorder (ASD).

Side effects of melatonin include nausea and headaches.

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 anti-epilepsy medication. There are many different anti-epilepsy medications, so the best one for your child depends on the type of seizures your child has. It also depends on any other problems your child has or other medications she’s taking.

Side effects vary with different anti-epilepsy medications. Common side effects include:

• sleepiness
• behaviour changes
• tummy troubles.

Assessing whether a medication works

When your child starts taking a new medication, you and your doctor need to monitor him carefully.

It can also help if you have 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 the behaviour happens, and think about how intense it is. Also pay attention to your child’s sleeping habits and appetite. This puts you 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’ve 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

Check with your doctor about whether the medication suggested has been tested with children with autism spectrum disorder (ASD).

Every child with ASD is different and not all medicines work in the same way for all children, so it can take a few tries and visits to your 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. Always talk to your doctor about stopping a medication.