Autism Spectrum Disorder: Parents’ Medication Guide Autism Parents’ Medication Guide Work Group CO-CHAIRS: Matthew Siegel, MD and Craig Erickson, MD, MS MEMBERS: Jean A. Frazier, MD Toni Ferguson, Autism Society of America Eric Goepfert, MD Gagan Joshi, MD Quentin Humberd, MD Bryan H. King, MD, Representative to the American Psychiatric Association Amy Lutz, EASI Foundation: Ending Aggression and Self-Injury in the Developmentally Disabled Louis Kraus, MD, Representative to the American Psychiatric Association Alice Mao, MD Adelaide Robb, MD Jeremy Veenstra-VanderWeele, MD, PhD Paul Wang, MD, Autism Speaks STAFF: Carmen J. Head, MPH, CHES, Director, Research, Development, & Workforce CONSULTANT: Eve Bender, Scientific Editor ©2016 American Academy of Child and Adolescent Psychiatry, all rights reserved. Table of Contents Introduction ..............................................................................................................................................................4 Assessment of the Child with ASD Experiencing Emotional or Behavioral Problems ......................................................................................................5 Primary Non-Medication Treatment Strategies for Emotional and Behavioral Challenges ................................................................................... 6 Medication as a Treatment Tool for Emotional or Behavioral Challenges .................................................................................................9 Symptoms and Medications ..................................................................................................................12 Controlled Medication Studies in ASD .........................................................................................16 Medication Tracking Form .......................................................................................................................21 References ........................................................................................................................................................... 22 Autism Spectrum Disorder: Parents’ Medication Guide 3 Introduction hat is ASD? Autism spectrum Why consider medication in ASD? People disorder (ASD) is a developmental with ASD often experience a host of W disorder characterized by problems difficulties that can be as problematic with social communication, unusual behaviors as the symptoms of ASD itself. Anxiety, such as fixed interests, being inflexible, having mood instability, impulsivity, hyperactivity, repetitive behaviors, or abnormal responses to sleep problems, and even aggression and sensations. Communication problems include self-injurious behavior can occur in some difficulty understanding and responding to people. Just as it would be for other medical social cues and nonverbal communication problems, medication may be helpful in such as gestures and tone of voice, which treating some of these difficulties. The can result in challenges in making or keeping use of medication is more often aimed at friends. Although people with ASD may want treating the symptoms of these associated to make friends, difficulties in understanding conditions, which we can characterize social norms or correctly interpreting language as emotional and behavioral challenges, and facial expressions can get in the way. than for core symptoms of ASD itself, as no medications have shown clear benefit In recent years, it has become clear that for social communication impairment or individuals with ASD, despite sharing some restricted, repetitive behaviors. behavioral challenges, can be quite different from one another. Some people with ASD Sitting down with an expert to discuss may be very intelligent, while others may have whether it is a good idea to try medication cognitive challenges. Some may have advanced for certain troublesome symptoms in your vocabularies and others may speak very little child with ASD is reasonable. Although or not at all. Previous attempts to subdivide the best approach to addressing those the population on the basis of language and symptoms may not include medication, it cognitive ability have not been supported by can be helpful to learn about various options research. Thus, people in the same family and/or begin to gather information on with autism or who share the same genetic the frequency and intensity of behaviors risk factor(s) can end up with very different that may ultimately be targets for symptoms and outcomes. medication treatment. 4 Autism Spectrum Disorder: Parents’ Medication Guide Assessment of the Child with ASD Experiencing Emotional or Behavioral Problems hen a challenge presents itself, it providers can assess the functioning of the is time for an assessment. The first family and how family relationships could relate W step in helping a child with ASD to to problems, as well as evaluate for co-existing get assistance with an emotional or behavioral mental health disorders in the child such as challenge is to have him or her evaluated by anxiety or ADHD. Psychologists and other an expert or team of experts. Since many experts in behavior can assess factors that may factors may contribute to these emotional maintain or reinforce the problem behavior(s), and behavioral problems in a child with ASD, it and can use applied behavioral analysis is ideal to have the child assessed by a team techniques, as outlined below. The possibility whose members can consider different causes of a medical issue underlying the emotional and approaches. In reality, most children will or behavioral symptoms can be assessed by only have access to a single provider, or the a physician or other medical provider. Finally, child’s emotional or behavioral problems are an occupational therapist can assess the role severe enough that there is a need to act of over or under sensitivities and challenges in quickly. Even in these situations, it is important daily living and self-help skills, such as dressing, for the clinician who evaluates the child to bathing, and eating. consider multiple sources for the problem, and refer the child for further assessment if needed. A thorough assessment of emotional or behavioral problems will take into account the possible role of communication, family functioning, factors that contribute to or exacerbate the behavior, physical health, co-existing mental health disorders, sensory factors, and daily living skills. The child’s ability to communicate should be considered and a speech and language pathologist can perform more formal assessments of language and social communication abilities. Mental health Autism Spectrum Disorder: Parents’ Medication Guide 5 Primary Non-Medication Treatment Strategies for Emotional and Behavioral Challenges Applied Behavioral Analysis (ABA) to communicate.2 Electronic assisted As demonstrated in a number of well communication devices include speech designed research studies, Applied Behavioral generating devices (SGD), which can produce Analysis (ABA) has been shown to be an electronic voice that communicates words. effective for addressing and often reducing These SGDs come in two main forms, dedicated challenging behaviors, as well as teaching devices (e.g. DynaVox, AlphaSmart, DynaWriter) many skills and routines. Parents frequently or software (e.g. Proloquo2Go or Touchchat) that have questions about how ABA works and can be used on personal computers, tablets, or how it will help their child. mobile phones. Children with ASD often have difficulty Speech-language pathologists can recommend learning. Applied Behavior Analysis (ABA) is an assistive communication system after an educational and therapeutic approach that a careful evaluation of the unique abilities, involves breaking down tasks and skills into needs, and communication goals of the their smallest parts, then teaching them slowly child. Preliminary studies have shown that while encouraging, shaping, and reinforcing assistive communication devices are generally functional behaviors and discouraging harmful liked by users and may improve functional or disruptive behaviors. ABA focuses on communication in children with ASD.3 the relationship between a certain behavior, the factors that were present before the Cognitive Behavioral Therapy behavior (“antecedents”) and the results of Cognitive Behavioral Therapy (CBT) is a type the behavior (“consequences”). ABA has been of psychotherapy in which a person’s negative successful in helping children with ASD improve thoughts are challenged in order to reduce Social skills are verbal communication, academic performance, social associated troubling emotions and behaviors. behavior, and adaptive living skills as well as CBT is “problem-based,” meaning that it is used and non-verbal 1 addressing specific problem behaviors. to address the specific concerns of a patient. behaviors necessary for CBT has been shown to be an effective treatment positive and effective Communication supports for anxiety in individuals with high functioning While speech is generally the preferred method ASD (HF-ASD), and it may also be helpful in social interactions, and of communication in our society, not all children addressing disruptive behaviors, like aggression, include eye contact, with ASD can use speech effectively. For children and in improving social and communication who have limited or no verbal ability, alternative 4 smiling, and asking skills. CBT is typically administered by a methods of communicating have been therapist, but parents and