AUTISM CONNECT DIRECTORY

Medical management of Autism

There is a lot of confusion or skepticism about the use of medicine in the minds of parents of children with autism. There are no strict rules or guidelines about medications for autism as none of them offer cure. But, having said that, one must remember that medicines play an important role in managing the symptoms of autism e.g. hyperactivity, sleep disturbances etc. Medicines are also required to treat associated illness such as seizures.

“Knowledge is power” Parents can make informed decision regarding medicines for their child if they have adequate information about its risks & benefits. Research has shown that 70 to 80% of children with autism have been prescribed medicines at some point. Along with prescription medicines many of these children are on complimentary or alternative medicine treatment. Vitamins, Probiotics & mineral supplements are also widely used.

Below we have discussed some options of medicines that can be considered after consulting your child’s doctor.

Prescription medicines

 

  • Risperidone and Aripiprazole are the only two US FDA approved medications for Autism.

  • They are used to treat irritability that is associated with behavioral problems like aggression, self-injury, temper tantrums and mood swings.

  • They act on the chemical substances which carry signals across nerve connections serotonin and dopamine, which have been found in abnormal levels in many individuals with autism.

  • The most common side effects of Risperidone and aripiprazole include drowsiness, constipation, fatigue, hyperglycemia and weight gain. In some individuals side effects like tremors, abnormal involuntary movement and rigidity have been observed.

Other Anti-psychotic medicines used to control aggression and hyperactivity are Clozapine, Olanzapine, Quetiapine and Ziprasidone. These medicines are usually prescribed to older children or adults as they are associated with serious side effects. In some cases, when the symptoms are too severe or unresponsive to standard drugs, these medications may be required.

Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used for treatment in autism. They include drugs namely Fluvoxamine, Fluoxetine, Citalopram, Escitalopram and Sertraline.

  • Treatment with these medications may help decrease frequency of repetitive behavior and improve eye contact and social interaction.

  • Side effects of SSRIs include anxiety, insomnia, nausea, vomiting, diarrhea, apetite and weight changes, mania or hypomania, aggressive behaviour. Suicidal ideation has not been reported as a possible side effect in studies on SSRIs in autism.

  • Other drugs prescribed are Nortriptyline, Amitriptyline, Clomipramine, Desipramine, and Imipramine.


    Stimulants

  • Drugs such as methylphenidate, amphetamine, and dextroamphetamine belong to the category of stimulants which act on the dopamine system and are primarily used to treat hyperactivity and inattention.

  • However, adverse effects such as loss of appetite, sleep difficulties, irritability, emotional outbursts, anxiety, depression, headache, and diarrhea have been reported.

 

  • This group of drugs can be used to treat behavioral symptoms such as aggression, self-injurious behaviors, impulsivity and conduct disorder.


    Antidepressants

  • Antidepressants can be used to treat depression,anxiety and obsessive compulsive disorder in autism.

  • Mood stabilizers possibly used include lithium, lamotrigine, valproic acid, carbamazepine, topiramate, oxcarbazepine and levetiracetam


    Antiepileptics

  • Antiepileptics are usually prescribed to control seizures associated with autism.

  • Commonly used Antiepileptic in autism is sodium valproate.

  • This drug have also shown improvements in the various core symptoms such ashyperactivity,receptive language, affective instability, aggression, and social skills.

  • Side effects of these drugs are a major concern. Routine liver function tests should be performed before and during treatment. Monitoring the drug levels through regular blood tests may be required.

  • Other drugs used are levetiracetam, phenytoin,topiramate, carbamazepine, lamotrigine, clobazam, etc

  • Midazolam nasal spray may be prescribed to keep handy with parents for emergency or during travel.

  • Divalproex sodium, an antiepileptic, is also prescribed to control hyperactivity.


    Glutamate antagonists

  • Glutamate antagonists used for autism are amantadine, memantine.

  • They lead to improvement in memory, hyperactivity, irritability, language, social behavior andself-stimulatory behavior.

  • Few patients were reported to have experienced adverse effects like worsening of autistic behaviors.

  • Some of the other adverse effects include nausea, diarrhoea, hyperactivity and irritability.


    Sedatives

  • Medicines like melatonin are prescribed in case of disturbed sleep cycle.

  • Triclofos is helpful to put the child to sleep during travel and also for insomnia.

  • Promethazine and haloperidol can be used when child is extremely aggressive, violent, excessively hyperactive or around any medical procedures.

  • These medicines have to be used very carefully and under supervision of a doctor only.

  • The side effects can be excessive drowsiness, day time sleepiness, fatigue, lethargy, etc

Non- prescription medicines

Vitamins/minerals supplementation helps improve symptoms of self-injurious behaviour, aggression and tantrums.

Omega-3:

  • Omega-3 plays an important role in the functioning of the brain. It also reducesinflammation and thus improves immune balance in autism.

  • Omega-3 supplementation improves cognition and motor skills, concentration, eyecontact, sociability and sleep, along with reducing hyperactivity, repetitive behaviour and aggression.

Folic Acid

  • Omega-3 plays an important role in the functioning of the brain. It also reducesinflammation and thus improves immune balance in autism.

  • Omega-3 supplementation improves cognition and motor skills, concentration, eyecontact, sociability and sleep, along with reducing hyperactivity, repetitive behaviour and aggression.

Vitamin D

  • According to researchers, oral vitamin D supplementation may safely improve symptoms of autism.

  • In a study, autism symptoms including hyperactivity and social withdrawal improvedsignificantly in patients receiving Vitamin D3 supplementation as compared with the placebo group.

Vitamin B12

  • Individuals with autism may be associated with deficiency of vitamin B12 due to poor

    • dietary intake, poor absorption, or metabolic abnormalities.
  • Methylcobalamin is the most active form of vitamin B12, which is required forhealthy development of brain, immune system and nervous system.

  • These supplements may help in controlling the behavioural symptoms in autism.

  • These can be given in the form of injections or tablets.

Vitamin B6 and Magnesium

  • The combined intake of vitamin B6 and Magnesium may result in improving social

    • interaction, communication, alertness, self-mutilation and repetitive behaviour.
  • Side effects of high dosages can cause neuropathy and diarrhoea.

Vitamin C

  • It is an antioxidant which prevents oxidative damage in brain, reduces metabolic

    • stress and improves immunity.
  • It may help improve repetitive behaviour in children with autism.

Vitamin E

  • It is also an anti-oxidant.

  • It helps in neurodevelopment of the brain and immunity.

  • It has shown to improve speech and behaviour in autism.

Zinc

  • Zinc deficiency is commonly observed in autism.

  • It is one of the important components for neuronal functioning.

  • Zinc supplements improve cognition and reduce hyperactivity.

Iron supplements

  • Iron deficiency has been observed in some children with autism.

  • This may be associated with psychomotor retardation, poor sleep, and neurological

  • and behaviour problems.

  • It has shown to improve sleep significantly without any side effects.

Multivitamins/mineral supplements

  • Vitamins/minerals supplementation helps improve symptoms of self-injurious behaviour, aggression and tantrums.

Dimethylglycine (DMG)

  • DMG is also known as Vitamin B15
  • It increases oxygen uptake in the blood and increases circulation.
  • DMG supplements may improve eye contact and social interaction, improve speech communication and increase tolerance and decrease aggressive behaviour.

L – Carnosine

  • L-carnosine is a naturally found in high concentrations in muscle, heart and brain tissues.
  • It has been shown to possess potential for improving language and behaviour in children with autism.

Probiotics

  • Probiotics are microorganisms which improve digestion and immune system.
  • They help to reduce self-stimulatory behaviour, aggression, stereotypical behaviour, hyperactivity and improve socialization.

Coenzyme Q10

  • It is a mitochondrial enzyme required for optimum cellular functioning.
  • It helps to reduce irritability; and improve communication and socialization.

The prescription drugs must be taken with caution and under supervision of a doctor only. Report any early signs of side effects to the doctor immediately.

Vitamins and other supplements can be taken in combination as advised by your child’s doctor. Always keep a regular follow up with your child’s doctor.