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When Should Drugs Be Used to Control Autistic Behaviors?

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Updated December 17, 2010

Question: When Should Drugs Be Used to Control Autistic Behaviors?
My 15-year-old son is seeing a psychologist for anger issues and a psychiatrist for suicidal thoughts. He has "meltdowns" once or twice a month and almost loses control of himself. He is on Zoloft which helps immensely, but the psychiatrist wants to try him on Depakote. My inner alarms tell me that it is not necessary for a twice-a-month episode. How does one decide whether the behavior warrants medication and the risks inherent with that medication (liver damage)? Am I wrong for refusing suggested treatment? Can this behavior be modified in other ways besides meds?
Answer: From Dr. Robert Naseef:

You are asking very intelligent questions and taking good care of your son by getting him the kind of help you are describing. Nonetheless, you are facing a difficult dilemma. When a child continues to have the kind of behavioral challenges that you describe, a psychiatrist will often recommend another family of psychotropic medications, such as mood stabilizers which could possibly help. A potentially dangerous behavior, even once or twice a month, warrants considering other options.

Remember this simple principle - when you are talking to a psychiatrist about a problem that hasn’t changed, expect to get a recommendation for more or different medication, or for psychotherapy. Since your child has been seeing a psychologist, it makes sense to at least consider another medication option. I suggest that you would benefit from Straight Talk about Psychiatric Medications for Kids by Timothy E. Wilens, M.D. Reading this book by a Harvard psychiatry professor will answer many of your questions - perhaps questions and concerns that your son’s doctor didn’t have the time to get into. Also, I would recommend that you talk to the psychologist who has been treating your son. Is there collaboration between the professionals? What does the psychologist think? What are the strategies being used? What are the results?

You are not wrong for seeking more information and insight. Research consistently shows that the proper combination of therapeutic strategies and medication is the most effective approach. You seem to have some doubts, and that is very understandable. Puberty does impact behavior and emotions and these changes can reverberate through the family. So taking the time you need to make wise choices is an option you can choose guilt-free. You may want to consider getting a second opinion. When the day is done, it is important that you have peace of mind about whatever decision you come to.

From Dr. Cindy Ariel:

The best course of treatment for issues you describe in your son usually involve a combination of both medication and therapy. The helpfulness of medication in this instance has been very clear, as the Zoloft has helped to decrease your son’s aggressiveness very noticeably. Since some of the problem behaviors are continuing, it could very well make sense to consider another class of medication to assist.

Fortunately, your son is also in individual therapy. It may be helpful to speak with the psychologist regarding the medication issues and treatment strategies. It has clearly been difficult for your son to learn the personal and social skills necessary to handle frustration and anger and deal appropriately with others. It is imperative that your son learn to deal with being told "no" without losing control. The medication may help him to stay calm enough not to act out, but will not teach him new ways to behave.

The changes in medication your son’s psychiatrist suggests may be a good idea for now to keep your son safe and in control and to keep those around him safe as well. In the longer run, he needs help to learn to handle anger and frustration in ways that will actually get him what he wants. More dialogue with both of your son’s treating doctors may be necessary for you to come to an understanding and to feel comfortable with their treatment plan as it progresses.

Robert Naseef, Ph.D., and Cindy Ariel, Ph.D., are the co-editors of "Voices from the Spectrum: Parents, Grandparents, Siblings, People With Autism, and Professionals Share Their Wisdom" (2006). On the web at http://www.alternativechoices.com .

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