After finishing my child and adolescent psychiatry fellowship training in 1997, I returned to New York interested in specializing in the treatment of children with Autism Spectrum Disorders. At that time there was not a single medication approved for the disrupting symptoms and behaviors related to autism. Sadly, of all the children I was treating, the children with autism, having failed or only partially responded to intensive behavioral therapies, seemed most in need of an effective pharmacological intervention. At that time, clinicians and researchers working in the field of autism all across the country were recognizing the overwhelming and growing need to identify effective medication treatments for these children. While clinicians began investigating treatment options, popular media and news reports were simultaneously frightening parents by often misrepresenting or over-emphasizing negative outcomes of medication use in children, and downplaying, or completely omitting, the possible benefits. Out of necessity and without the benefit of FDA approval or large scale studies, my colleagues and I met with many concerned parents who were facing the difficult decision of whether or not to try medication for their child’s disruptive symptoms and agitation.
Prior to FDA approval of medications specific to the autism pediatric population, decisions to medicate were made utilizing the best available evidence, coupled with clinical expertise. When all available options failed to alleviate the devastating symptoms these children were experiencing, I began prescribing risperidone (Risperdal) ‘off-label’ for my toughest cases, with considerable success. My colleagues across the country were reporting similar findings. Over the next several years, with the thoughtful consideration and agreement of parents, we were effectively treating dozens of children with autism for disruptive and agitative behaviors with a medication that lacked FDA approval for this patient population. Had we decided to wait for the FDA’s endorsement, countless children would not have received what some parents considered to be life altering benefits throughout the toughest and most critical years of their child’s development. Fortunately, large scale studies of the use of risperidone in children with autism eventually led to FDA approval. While there is yet no medical “cure” for autism spectrum disorders, Risperdal, and more recently Abilify, are now FDA-approved medications for the treatment of irritability and agitation in children and adolescents on the spectrum.
The reality was, and still is, that for some children with autism, particularly around adolescence, therapeutic interventions and intensive behavioral supports may be inadequate to enable progress. In these cases, the addition of medication can be a constructive addition to the interventions utilized. Still, administering medications to children feels worrisome for some parents. Even today, with better research-backed support, choosing to medicate remains a difficult choice. Parents fearful about the idea of medicating their child are not alone; many parents of the children I am currently treating with medication expressed similar uncertainty and skepticism during our initial consultation. In my experience, it is fair to say that most parents would prefer not to treat their child with medication if other options could be, or had been, effective. For the majority of parents, medication treatment is considered to be a last resort. Unfortunately, in too many cases, fear and reluctance to medicate often means that a child’s first meeting with a psychiatrist is months or even years after the situation has risen to the level of a crisis.
The discovery of the clinical benefits of Risperdal and Abilify in treating associated disruptive and agitated symptoms of autism were the result of an ongoing surge of advancements in all areas of pediatric medical science and research. New research also suggests that the vast majority of individuals with various forms of psychiatric and neurologic disorders may also be more at risk for developing other conditions and difficulties over the course of their lives. The idea that someone meeting criteria for a psychiatric disorder will simply “grow out of it” is, unfortunately for many, wishful thinking. Early diagnosis and detection of common co-existing conditions such as ADHD, mood, and anxiety disorders are therefore critical to achieving the best overall prognosis for those suffering with psychiatric and neurologic disorders. Psychiatric medications can be helpful in alleviating co-existing problems with aggression, mood instability, impulsivity, inattention, anxiety, and compulsive behaviors, which often interfere with behavioral therapies, social relatedness, academic functioning, and overall progress. Parents who remain concerned or fearful about choosing the medication option must carefully consider what the potential cost of not treating their child with medication may be. While there are certainly risks to every medication option, the other side of the matter must also be thoroughly considered: “What if the problems my child is struggling with do not go away?” “What are the risks to my child’s development and to their overall self-esteem if they continue to regress in family, social, academic and vocational functioning despite behavioral and educational supports?”
Today’s parent still faces the tough decision of whether or not to consider pharmacological treatment for their child. Thankfully, a growing national awareness and interest in autism and related conditions continues to fuel the research and development of more effective and better tolerated medications. The superabundance of information aired in the media and over the internet requires that parents with a child on the autism spectrum become quickly proficient in their ability to sort through and discern good information from bad. Sifting through the vast outpouring of materials and resources to find reputable sources of information can be, at times, daunting and too often misleading. Sometimes, the parent’s exhaustive search for more information only serves to create further confusion, uncertainty and escalating fear. It is therefore critical that parents, exploring medication options for their child, consider consultation with a physician who has experience, or specializes in treating children with Autism Spectrum Disorders. In consultation, parents are encouraged to speak openly about their concerns while seeking the assistance, support and education necessary for making crucial decisions about medication treatment for their child.
Today’s parent still faces the tough decision of whether or not to consider pharmacological treatment for their child with Autism or Asperger’s Syndrome. Thankfully, a growing national awareness and interest in Autism Spectrum Disorder (ASD) and related conditions continues to fuel the research and development of more effective and better tolerated medications.
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