Your Child and Medications—Autism Toolkit

What types of medications are used?

• Stimulants can be used to treat hyperactivity and not paying attention.

• Atypical antipsychotics can be used to treat irritability/getting upset easily.

• Selective serotonin reuptake inhibitors (SSRIs) can be used to treat anxiety (or nervousness) and depression.

• a₂-adrenergic agonists can be used to treat hyperactivity.

• Anticonvulsants can be used to treat seizures.

• At this time, risperidone and aripiprazole (both atypical antipsychotics) are the only medications that have been approved by the US Food and Drug Administration specifically for children with ASD and are approved to treat irritability (including aggression, deliberate self-harm, and tantrums).

The medication you choose depends on your child and his unique behaviors. Medications are not helpful for all children with ASD or for all problem behaviors. Medication may be prescribed by the child's pediatrician or family doctor or by a specialist.

What should I do before my child starts a medication?

Work with your doctor to decide if and when to start a medication. It is important to find out if there are any things that might be making the behavior happen for longer or more often. Look for medical factors that might be causing or increasing the intensity or occurrences of behavior. For example, your child may have a hidden source of pain, such as an ear infection, that leads to self-harm. Maybe a change in routine at school or home is upsetting your child. Sometimes, if you address these things, there is no longer a need for medication.

Talk about treatment options other than medication. Often, behavioral strategies are the best way to decrease problem behaviors. Behavioral strategies may be started first, and if they do not seem to work, you may want to start a medication. Medications are most often used with behavioral strategies, not instead of them. Once in a while, medication may be needed by itself when the safety of the child or others is at risk.

Your child's pediatrician may recommend medication for your child if problem behaviors make learning, socializing, health and safety, or quality of life hard. If your child is not responding to behavioral treatments, she may have another diagnosis, such as depression or epilepsy, that is treated with medication.

Ask your child's pediatrician about benefits and side effects of any medication. It is important for everyone who cares for your child, including family, teachers, school nurses, and other caregivers, to know what to expect. You should also tell your child's doctor what other medications, including dietary supplements and other treatments, your child is taking.

What happens after my child starts a medication?

Many children with ASD do not need to be treated with medication.

Before a medication is started, it is important to know what the goal is for the medication. If it is to decrease a particular behavior and to increase other behaviors, then those "target behaviors" should be listed and shared. Since any medication can have side effects, it is also important to know what they are and to watch for them. Your child's pediatrician may ask you to fill out a checklist to help watch for behavioral changes or side effects. Your child's pediatrician may want teachers, therapists, and other caregivers to tell you about changes they see in your child. With some medications, your child may need blood tests or heart monitoring from time to time to watch for possible side effects of the medications.

Your child's doctor may recommend changes in the amount of the medication depending on how well it is working and whether there are any side effects. The amount may also change as your child grows. Your child's pediatrician should continue giving a medication only if the benefits are greater than any side effects.

How can we use medications safely?

Give medications exactly as the doctor tells you. This means in the right amount and at the right time of day. Everyone forgets to give a medicine on time once in a while. Ask the doctor or pharmacist what to do if this happens.

Do not stop, restart, increase, or decrease medications without asking the doctor first. If a medicine seems to stop working, it may be because it is not taken regularly. Your child may be hiding the medicine in his cheek, stashing the medicine somewhere in the house, or forgetting to take it (especially at school). Doses may be too far apart, or your child may need a different dose now. Something out of the normal may be upsetting your child, or there may be new problems that need to be worked on. Talk with your child's pediatrician about your concerns. Do not just increase the dose or suddenly stop the medication!

Keep all medicine out of the reach of all children, and watch your child when he is taking medicine. If your child takes too much of a medicine, call your child's pediatrician or Poison Help (1-800-222-1222), or go to a hospital emergency department right away.

Each medicine has a generic or chemical name. Just like dish soap or paper towels, some medications are sold by more than one company under different brand names. The same medicine may be sold under a generic name and several brand names.

Generic medications usually cost less than brand-name ones. These have the same chemical formula, but they may not be exactly the same strength as brand-name medications. Ask your child's pediatrician or pharmacist if your child should take a specific brand name of medicine. Medications come in different forms including liquid, tablet, capsule, and patch. Talk with your child's doctor about the options and what would work best for your child. Some medications must be renewed each month. Make sure you have a system to keep track of your child's medicine so that you do not run out.

A medication might cause an allergic reaction. Allergic reactions include hives, itching, rashes, swelling, and trouble breathing. Even a tiny amount of a medication can cause a reaction in patients who are allergic to it. If your child has a reaction, call your child's pediatrician or pharmacist right away. Be sure to talk with your child's doctor before restarting a medication that has caused an allergic reaction in the past.

Medications might have side effects. Your child may experience side effects, and you might not be sure whether a symptom is caused by the disorder being treated or the medication itself. Talk with your child's pediatrician if you are worried.

Taking two or more medications at the same time may cause more side effects or cause one of the medications to not work as well. Always ask your child's doctor, nurse, or pharmacist before adding another medication, prescription, or over-the-counter drug. Be sure that each doctor knows about all the medications your child is taking. Also, tell the doctor about any vitamins, herbal supplements, or diet supplements your child may be taking. Some of these may have side effects alone or when taken with medication.

Everyone taking medication should have a checkup at least once a year in addition to routine medication monitoring visits. It is very important to take your child to follow-up visits that are scheduled by the pediatrician, to check your child's response to the medication, and to watch for side effects.

If you think your child is using street drugs or alcohol, please tell the doctor right away.

If you think there's a chance your child could be pregnant, please tell the doctor right away. Pregnancy requires special care in the use of medicine.

Use one pharmacy for all your child's medicines. Some medications can interact with one another. These interactions can range from mild to serious. Your child may have more than one doctor prescribing medications for him, and the doctors may not know about other medications your child is receiving. Using one pharmacy will help decrease the chance of bad drug interactions by allowing the pharmacist to review all your child's medications.

Ask for childproof bottles for your child's medications. Unintentional taking of prescription medications could be serious. Childproof bottles can help prevent this. So can storing your child's medications in a safe place he cannot reach.

Ask how and where your child's medications should be stored and dispensed. Many people keep medications in the bathroom. The humidity in there can damage pills. Other medications need to be refrigerated. Some liquid medications must be shaken before being given to a child. Ask your child's pharmacist about these issues when you pick up a prescription.

If your child's medication is in liquid form, ask for something to measure it. Teaspoons and tablespoons used for eating are not accurate for measuring. Syringes and small medicine cups with accurate measurements are available from your child's physician or pharmacist.

Please note, printed information like this handout talks about children and adolescents in general. As researchers learn more, advice changes. Even experts don't always agree. Many medications have not been approved by the US Food and Drug Administration for use in children. For this reason, use for a certain problem or age-group is often not listed in the Physicians' Desk Reference. This does not necessarily mean that the medication is dangerous or does not work. It means only that the company that makes the medication has not asked for permission to advertise the medication for use in children. Usually, this is because it is expensive to do the tests needed to get that permission.

If you have questions about the medication or if you notice anything unusual, please ask your child's doctor or nurse!

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