Tag Archives: behavioral pediatrician

Autism Q & A: What medications are available to treat autism?

By Daniel B Kessler

There are no medications that treat the core challenges of autism, though you can bet the pharmaceutical companies and autism research centers are working on developing some. What we do have available treats only the symptoms or behaviors but that is often so important by itself.

If a child’s behavioral (disruptive behavior or aggression) or emotional (anxiety, obsessive tendencies, sensory overload, meltdowns) challenges limit his or her ability to participate in and therefore benefit from educational, therapy or recreational activities, then these symptoms may be legitimate targets for a medical approach (that means the judicious, careful trial of medications). Medication, used appropriately, doesn’t control behavior. It should allow the child to be in control of his behavior.

The decision to use medication rests with parents. Don’t let anyone tell you different. Find someone to answer your questions and address your fears. Talk to parents who have decided to go ahead and place their child on medication and those that have not. Ask them to let you know their reasons and experiences. But be careful about third-hand accounts (“I know one parent whose sister’s kid had a really bad reaction to ____”).

No parent is excited about having to use medication. Every medication has potential side effects — even “over the counter” medications or “natural” supplements.

But there is also a cost to not getting help for these behaviors. The child may not benefit as much as he or she could. While on medication a child may do better; progress more quickly, with the ability to better regulate their behavior or emotional reactions. Once again, information helps. Ask questions. Look at reliable sources of information. What is this medication supposed to do? How does it work? How long will it take to show a benefit? Has it been studied in children with autism? Has it been shown to be safe and effective? If not FDA-approved and being used off-label* has it been used for children with autism? Has this doctor used it to treat kids with autism?

Next: What are the potential side effects? 

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

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*Off-label use is the practice of prescribing a medication for a condition, or an age group, for which it has not been reviewed and “approved” by the Food and Drug Administration.  It is up to the manufacturer of the medication to submit an application for approval. However, the FDA does not have the legal authority to regulate the practice of medicine, and any physician may prescribe a drug off label.

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Autism Q & A: What happens when it’s time for kindergarten?

By Daniel B. Kessler, M.D.

Most children who have received special education preschool services will continue to need additional supports in the transition to kindergarten. This is usually true for a child on the autistic spectrum. Also, at age 6, children who are receiving services under the Division of Developmental Disabilities (DDD) and/or Arizona Long Term Care Services (ALTCS) will be required to see a specialist to re-certify their diagnosis.

This is where some families run into difficulties if their child has not received a formal diagnosis of autism. Based on existing state law, the diagnosis must be autistic  disorder. A child will not qualify with a diagnosis of PDD-NOS, Asperger syndrome or autism spectrum disorder. (This will become more of a problem after the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in May 2013, as it is widely expected that current disorders related to autism will now fall under the category of autistic spectrum disorders and there will be no “autistic disorder.”) The only way children who do not have not a diagnosis of autistic disorder can qualify for services is if they meet the criteria for one of three other categorical disorders (defined in law) that include seizure disorder, cognitive impairment or cerebral palsy. These conditions are covered by the ALTCS system by law.

It is not uncommon for a child who had been receiving services under the category of “at risk for autism” (a description sometimes used by providers for younger kids) to lose services if further evaluation fails to support a diagnosis. The child may have been receiving services including speech therapy and occupational therapy and making good progress and the family may wish to continue those supports through DDD even though the child also will be attending a kindergarten program. Parents are upset when their child “loses” the services because he or she doesn’t have the right diagnosis.

Parents should request (in writing) a comprehensive re-evaluation to determine the extent of services and supports available through the school district. Evaluations always must be performed in all areas of suspected disability. Schools often will tell parents that because autism is a medical diagnosis they do not test for it, but the courts have ruled that because autism is also an educational eligibility category (at least by the time the child is entering kindergarten), to not test for it the school is denying the child a free and appropriate education (FAPE). The bottom line is that schools must test for autism in their comprehensive assessments if there have been concerns expressed about it or parents suspect it.

Next: What it means to place a child in a “least restrictive environment.”

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

Meds Q & A

By Daniel B. Kessler, M.D.

In my last blog, “The Medication Equation,” I talked about fears and hesitations you may have about the all-important decision of placing your child on medication. As a follow up, given the complexities of this decision, I’d like to offer answers to some of the most common questions developmental and behavioral pediatricians like myself receive surrounding meds.

The usual disclaimers should apply to this information as this is not intended to be medical advice for your child. Rather, it is intended as a great conversation starter with your own pediatrician.

Q: Why does the doctor change my child’s medication?

A: Although much is known about the use of medications to treat certain conditions like ADHD, each individual situation may involve some degree of trial and error. For example, if one drug fails to help a certain symptom such as hyperactivity, that is no prediction of whether another member of the same class of drugs might not be helpful. Your child is unique and so is his or her body’s response to various medications.

Q: What information should the doctor give me about the medication?

A: The doctor should tell you when the medication is expected to work. Some medications may work in 30 minutes while others may take eight weeks to be effective. You also should be told what side effects might be expected. For example, will the medication make your child sleepy? You should also be told if the medication might interfere with any medication your child is taking or might take in the future.

Q: How do I know if the medication is working?

A: Your child’s doctor will share what to expect if the medication is helping. You may wish to ask your child’s doctor specific questions such as, “Will it be easier for Amy to concentrate at school?” There might also be a measureable way to assess the effectiveness of the medication for the condition being treated, even if it is just a behavioral questionnaire.

Perhaps the most important point to share with you is that medication should be viewed as just one part of an overall treatment plan for your child – but it may be a very important and useful part! Do not be afraid to ask your child’s doctor for more information, as they are there to help you and your child.

Daniel B. Kessler, M.D.

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.