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ADHD, Autism, and Medication
The use of medication for concerns with attention, impulsivity, staying on task and related issues among children with autistic spectrum disorders is very common. As with many medications, their use depends more on “target symptoms” rather than specific diagnoses. A target symptom is a behavior or symptom that is interfering with the child’s social-emotional status or ability to perform his or her daily responsibilities.
Many children with Asperger’s Disorder and other ASD’s do share symptoms that overlap with ADHD. They are often inattentive, easily distracted, off task, hyperactive, impulsive, impatient, or have difficulty starting and stopping tasks requested of them at school. Obviously a child can have all or some of these symptoms. The thinking on the part of physicians who use medication is, by treating some of these symptoms characteristic of ADHD children can be more available to learn, and participate in social settings in a more appropriate and productive way.
There are several points parents need to consider when deciding to use medication to treat these symptoms. First, is medication being used to make the child fit into an educational or classroom environment? Are there changes that could be made in the classroom or by the teacher that would alleviate the symptoms interfering with the student’s success? Medication should never be considered a replacement for appropriate modifications and accommodations.
Secondly, parents need to know that medication in isolation rarely is effective. Medication is part of a treatment plan. Children still need to work on building the skills the medication is trying to modify.
Third, choosing the right medication is a partnership between the family and the physician. In general the stimulants (Ritalin, Adderall, Focalin etc.) are the class of medications used to treat ADHD, however there are other medications such as Strattera (atomoxetine), Tenex (guanfacine) and Catapress (clonidine) that are also used in certain circumstances. If we accept for the moment that the stimulants are the gold standard of ADHD therapy it is important to know the side effects that may limit their use. Principally these are insomnia, lack of appetite, tics, and in some individual’s anxiety can be worsened. Some of these side effects improve after a few days or weeks others may not. It is the role of the prescribing physician to work with you in assessing the impact of side effects while maximizing the benefits of the medication. The same is true in other respects for all of the medications mentioned. The key is confidence in your doctor and a clear understanding of risks and benefits.
With all of the recent publicity regarding drug manufacturers and the FDA, including recent warnings about cardiac problems and stimulants, parents are understandably cautious about using these medications. I have included some useful websites at the end of this article to assist you in being well informed. Medications, including the stimulants, can still be used safely and effectively. Monitoring and proper dosing by a well informed doctor are a good way for parents to alleviate their own anxiety about giving their children medication. There is an added layer of responsibility and worry when the medication is being given by you, by choice, to your own child. But, this is not a reason to shy away from the prospect of tremendous benefit. Medication should not be used if it doesn’t have a significant positive impact on your child’s life. And if it does, the medicine becomes a welcomed ally not a feared unknown and the decision to continue using the medication is much easier.
Medication for ADHD type symptoms is not 100% effective, about 25-30% of children are what we call non-responders and we cannot find a medication that works sufficiently well with limited side effects. Certain children, like those with tics or Tourettes, have to be carefully followed when using the stimulants as they can worsen these symptoms. Parents also need to be mindful that just as there is a risk to using medication there is also a risk to not using medication. Untreated symptoms can sometimes lead to careless behaviors, impulsive acts, doing without thinking and other concerns which make children more prone to poor decisions, accidents, and even self-medication with drugs or alcohol. There is often a “not quite right” feeling the child may have, and in some instances the medication can help.
Whatever your decision stay informed and remember, you can always trial medication without being committed to using it. Also it can be discontinued at any time with a doctor’s supervision.
Recommended websites for information on any medication or diagnosis include: www.fda.gov, www.nimh.gov, www.aap.org, www.aacap.org, www.dbpeds.org
To contact Dr. Ramos or learn more about her practice, click here.
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