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
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.
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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