Medication for Autism?

As summer comes into full swing, parents of children who require special education are given the task of considering their next steps. General education environment? Cluster class? Pull-outs?

The most common comments in their children’s IEP are lack of focus, anxiety when transitioning, not listening and not following directions. Disruptive behaviors include acting out, tantrums, and touching or hitting others. Ultimately, those actions are the key elements that guide choices, not the positive skills that the child has acquired, such as speech or academics.

The interventions that are offered depend on the professional who is asked to intervene. Psychologists might recommend counseling and medication. Psychiatrists often consider anti-anxiety chemicals, from blood pressure meds, such as propanolol and guanfacine (Intuniv), to Prozac and Zoloft – even for a 5 year-old.

Neurologists are not only quick to offer meds, but also feel pressed to advise that biomedical interventions are a “waste of time and money.” Many pediatricians think that stimulant drugs such as Vyvanse, Focalin, Concerta, Ritalin or Adderall will bring relief. In most cases, the children are rarely considered as suffering from a medical condition that requires a thorough evaluation with close observation and follow-up care.

The major problem is not a personality disorder, hyperactivity or true attention deficit. It is immaturity. Affected children were often ‘absent’ from neuro-typical development in their earliest years. So, a 4 year-old personality, for example, may be forced to interact and learn in a 6 year-old environment. Why don’t we put toddlers in first grade classrooms, even if they can read? Because they are not ready for it – socially and emotionally.

Assigning autistic children to a mismatched social environment is a recipe for failure or even disaster. Our present educational system can barely address the needs of ‘normal’ kids, let alone the onslaught of students who require special evaluation and interventions.

Many affected youngsters continue to suffer sensory issues, low muscle tone, and other limitations that need to addressed in order to succeed in school. Those children who either recognize their weakness and have self-esteem issues, or others who just don’t even ‘get it’, may resort to immature behaviors such as silliness, loud noises, or other disruptive mechanisms in order to achieve some attention from other students and adults. As with halitosis, negative attention is better than no attention at all. This season would be the time to explore alternative therapies that address issues such as:

•Hearing desensitization for those with auditory issues.
•Vision evaluation and intervention for patients exhibiting problems in eye contact and focus.
•Evaluation for dyslexia when problems exist with letter, word or number reversal.
•Sensory reduction by various means that best address your child’s individual sensitivities.

This may also be a good time to check out if there is any improvement to be provided by the proven neurofeedback therapies. Learning to swim, not only for safety’s sake, helps cognition by forcing patients to stay awake and aware. Hippotherapy can accomplish a similar awareness, due to smell, position, balance and, of course, the animal.

Perhaps the most valuable experiences that come from the summer break are found in those families who travel back ‘home’, whether to another state or country. The children get to experience the love and affection of family and have the opportunity to play with other youngsters who are usually more understanding of their special circumstances. This is a chance, in a relaxed environment, to observe and learn from others and to practice the skills that will likely result in an improved educational experience later in the year.

I frequently point out to our parents that I am certain there is no pill for immaturity. If there were, my wife would be administering it to me on a daily basis. Patience, practice, understanding and acceptance is the best cure for that situation.

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Brian D. Udell MD
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