By Temple Grandin, Ph.D.
 
(Temple's writes an exclusive column, "Autism: The Way I See It" that appears in each issue of the Digest)

There has been much publicity lately about the hazards associated with certain medications such as antidepressants and pain relieving drugs for arthritis. It has raised concern among parents whose children already use medications and made more ardent skeptics of parents who already are hesitant to use drugs with their child.

All medications have risks. When making decisions about medication usage, the benefits should clearly - not marginally - outweigh the risks. Common sense dictates that drugs with a higher risk of bad side effects should be used more carefully than drugs that have low risk. A reasonable approach for parents to keep in mind is that a drug with a lower risk of side effects should be tried first.

To approach medication decision-making in a logical manner, it is best to follow these four principles. These principles assume that non-drug approaches have already been tried and proved unsuccessful in alleviating the challenge.

• Try one medication at a time so you can judge its effect. Do not change educational programs or diet at the same time a new drug is tried. Keeping a journal of the child's behaviors, demeanor and levels of activity can be helpful in spotting side effects and/or assessing the degree of improvement, if any.

• An effective medication should have an OBVIOUS beneficial effect. Giving a child a powerful drug that renders him only slightly less hyper would probably not be worth the risk.

• Antidepressants (both SSRIs - serotonin selective reuptake inhibitors - such as Prozac and older tricyclics) and atypical antipsychotic drugs such as Risperdol should be given at lower doses to people on the spectrum than to the general population. Some individuals with ASD need only one-quarter to one-half of the normal starter dose. Many problems with antidepressants are caused by giving too high a dose: insomnia and agitation are two such examples.

• If an individual has been on a medication that is working really well, it is usually not worth the risk to change it for a newer medication. Newer is not always better.

To make good decisions, parents need to know all the risks involved with the major classes of medications. The following examples of risk versus benefit may help.
· Antidepressants - these come with a 'black box' label warning of a slightly increased risk of suicidal thinking during the first few weeks of use. This risk usually occurs during the first two months on the drug.
· Atypicals such as Risperdol - the side effects are high weight gain, diabetes and tardive dyskinesia (Parkinson's Shaker). There is no black box warning on the label, but the risks are actually greater than those associated with antidepressants. Gaining 100 pounds can seriously compromise health, impair mobility and contribute to social ostracism and low self-esteem. The risks continue and tend to get worse the longer the drug is taken.

In terms of real risk, the antidepressants are safer for long-term health. However, there are some situations where the benefits of Risperdol far outweigh the risk. It is a very effective drug for controlling rage. If it enables a teenager to attend school, live in a group home, or have enough self-control to learn other cognitive forms of behavior management, it could be worth the risk.

Parents must logically assess the risk-benefit ratio when contemplating any form of medication usage with their child. Discuss the medication thoroughly with the child's doctor. Ask him/her to provide you with a list of possible side effects of the medication. Do some research of your own on the internet to determine how widely and/or effectively the medication has been used with people with ASD. This is especially true when medication is suggested for use with younger children. Physicians sometimes recommend that drugs that have been proven effective for use with adults be given to children. Ask whether or not research has been done on the effects of the drug with a younger population. That is certainly one of the risks of which you should be aware, but one that is not usually printed on the product literature!

The use of medication, especially with school-age children, is never an easy decision. Weight the risks and benefits carefully before proceeding.

BIO
Temple Grandin is the most noted high-functioning person with autism in the world today. She is the author of two books on autism: Emergence: Labeled Autistic (1986) and Thinking in Pictures (1995), and is coauthor with Kate Duffy of the book, Developing Talents: Careers for Individuals with Asperger Syndrome and High-Functioning Autism (2004). In her 'day job' she specializes in designing livestock handling systems. Temple devotes much of her time to increasing awareness of autism through extensive speaking engagements. She makes her home in Fort Collins, Colorado. For autism resources by Temple Grandin visit www.templegrandin-autismvideos.com

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