Conversational Therapy

So, I’m sitting on the couch in the home of one of my clients – a beautiful 4-year-old girl, whom I adore.  I have lugged in my huge bag of stuff – activities I have planned to target the language skills we are building.  But, as this is just after Christmas, as well as a vacation for her, she is full of things to tell me.  This is such a joy to me.  I’ve known this little girl since she was barely verbal and on this day, I can barely get a word in edgewise.  So, in addition to just enjoying her enthusiasm, I am reminded to “kick in” my therapist side and make the most of this in supporting and furthering her conversational skills. 

Following are some of the ideas I used with her and some others for beginning conversational partners. 

But, first:  by “beginning conversational partners”, I am referring to children who are just expanding their skills in this interactive way, but not yet proficient in maintaining or adequately holding up their end of the conversational thread. 

Basically, a beginning conversational partner:

·       Has some advanced language abilities (e.g., combines 3 or more words together, can answer and ask simple wh questions)

·       Has social awareness of others

·       Is able to reflect on situations and consider different perspectives

·       Is able to inhibit behaviors based on social and moral rules

And next:  conversation as defined as a two-way communication in which each person takes a turn at the right time, sending messages back and forth. 

Formally, the Rules of Conversation are:

·      Pay attention to the person you’re interacting with

·      Start conversations

·      Respond when others start conversations

·      Take a turn at the right time

·      Give the other person a chance to take a turn

·      Continue taking turns, staying on topic

·      Consider the other person’s words, body language and point of view

·      Clarify or “say it another way” when your listener doesn’t understand

·      Ask the other person for clarification when needed

·      Change the topic when suitable

·      End the conversation appropriately

There are a lot of rules and even adults have trouble following them all.  Just imagine how difficult it is for your child to learn them!  S/He is going to need your guidance and support to learn how to have conversations that are rewarding for both of you. 

So, then: the ideas.

1.  Decrease questions, increase comments.  This allows your child opportunity to develop his/her own thoughts further.

Many parents find themselves asking their children question after question in an effort to get a response.  If you find yourself asking your child many questions, you’re not alone.  It’s a natural reaction when your child has communication difficulties.  But too many questions may turn your child off conversations.  So, to limit the number of questions you ask your child, turn some of your questions into comments or statements.

Instead of a question                          -----             Try a comment

“What’s that?  Is that a bird?”            ------               “Hello, bird!”

“That’s a big truck, isn’t it?”              -----               “Big truck.”

“Do you like that juice?”                        -----              “Mmmm! I like this juice.”

Balance your questions with comments.  Here’s a general guideline:  For every question you ask your child, try to make at least 2 comments.

Questions can be conversation stoppers when there are too many, or when you ask questions that your child doesn’t have time to answer, that test your child’s knowledge, are too hard for your child to answer, don’t have anything to do with what your child is interested in, or answer themselves.

(okay now that I harped on reducing questions…)

2.  Question for clarification.  Help your child recognize missing listener information.  This doesn’t, however, always need to be phrased as a question.  For example, my client was telling me about sledding in the snow and about “the blue”.  So I tried, “the blue …?”.  This would be an example of a least intrusive prompt, but in this case I didn’t get clarification.  So I went on to asking, “Was it a blue sled?”  Reply, “no, it was a tube! A blue tube and …”, the conversation continued. 

3.  Redirect for topic maintenance.  Again, as an example with my girl, our conversation continued, but then took a turn into telling about a recently seen movie.  I acknowledged the information (“oh, you are telling me about …”), but then I redirected (“but we were talking about …, tell me more about …”).

4.  Add your own information on the topic.  Allow your child the opportunity to respond to your perspective.  If your child is talking about sledding, add comments such as “I liked when _____!”, or “It’s cold when the snow gets on my face.”  Then allow time for your child to reflect and try to act on your ideas.  Don’t be discouraged however if s/he doesn’t right away, but instead goes on talking about his/her own experience.  This is a more difficult task to take on, but will come with time.

Feel free to comment or send further questions!

Happy New Year and fun conversations,

Dawn

Toys!!

Engaging children with ASD in play can be challenging. We want toys that stimulate and assist in development, but play also needs to reflect enjoyment for the child, and provide an outlet for stress relief and coping.  Here are some things to consider:

Special Interests

When choosing toys, think about what the child likes. Many kids with ASD have a deep interest in a special subject. Does the child you are shopping for have an interest in a particular subject? If so, look at gifts in these areas. If the child is interested in dinosaurs, cars, or planes, then look at toys or books related to this area. The only risk here is that s/he can rely too much on a single interest and not be challenged to try and engage in other areas where interest lacks.  At the same time, don't overdo the functional play.  There are times during which it is fine to let your child simply enjoy a line of toys that is pure fun. Balance is important. 

Developmental Ability

Consider developmental ability rather than age. Some children may be in grade school, yet their developmental age may be closer to preschool.  Good toys for children with autism who interact very little with other people are cause-and-effect toys. These toys teach that actions can cause something in the environment to change and can provide simple positive interactions between the child and others.  A child who is beginning to notice peers might be ready for simple turn-taking games.

Look for Toys that Stimulate the Senses

Is the child visually oriented? If so, think about interesting visual toys or items such as disco lamps, sand panels, light twirlers or fountains. Does s/he seek to touch lots of things? If so, think about toys that are tactile. Good tactile sensory toys for children with autism must be durable and interesting to touch. Some popular sensory toys include those with vibration, tangle or fidget toys, and toys with interesting textures (e.g., books with cloth, foil, yarn, etc. attached to them, or toys with bumps, fur, raised elements, ridges, etc).

Toys that Help Social Interaction and Language Development

Teaching all children cooperation through toys is an important rite of growing up. For children with ASD, socially interactive toys are even more important for helping them to develop coping mechanisms when interacting with the wider world. Board games are excellent for this, especially when the whole family pitches in to play together. Focus especially on the issue of taking turns and not getting uptight about losing. All children need to learn these skills but the frustration element can be very intense for children on the spectrum.

Toys that Develop Motor Skills

It's really no different from what all children need but you might have to face tactile defensiveness, inability to balance, fears, etc.  Many children have difficulty with fine motor skills. These are skills that require them to use their fingers and hands (like holding a pencil). Simple fine motor toys that are fun can also help children on the autism spectrum develop this essential skill.

Select quality over quantity. Too many toys can feel overwhelming and crowding. It is better to choose one good quality toy over many cheaper toys that will create great clutter. If you hit the right choice, that one toy will provide many hours of enjoyment.

Search online. There are numerous stores catering to toys for children with special needs, offering advice, good ideas, and unique products.

Information adapted from

www.nationalautismresources.com

www.autismspeaks.org

Gesture as Communication

Do you remember when your child said his/her first word?  Or, are you still waiting to hear it?  It is a moment every parent looks forward to -- the chance to communicate with your child.  But look closely, there are so many more ways that your baby can communicate with you.

 (side note: by "baby", I mean children of any age! - mine will forever be my babies no matter how old they are!)

So today, consider the gestures your child uses to communicate with you. Yes, gestures are an important part of communication, at all ages.

Gestures are actions produced with intent to communicate.  Gestures are expressed using fingers, hands, and arms, but can also include facial features. Early examples include open-handed reaching, reaching up to indicate want to be held, pushing objects away in protest, and arm flailing. The importance of gestural communication is often underestimated. 

Children learn gesture through observational and imitative learning.  There is an important social interaction component to this imitative learning that is required. Communication must be developed from social interaction.  In other words, digital entertainment or TV will not develop communication that can be interpreted and used in natural contexts. Many children with autism spectrum disorders will use scripts derived from TV programs, movies, commercials, etc.   While this is a form of language learning, it is not initially functional for 2-way communication.

Developmental Examples of Gestural Communication

• protest by body signal (e.g., back arching), or push away objects
• request by pointing, reaching, or making physical contact with an adult
• request action by reaching to be picked up, or performing an action to indicate want for something to reoccur
• seek attention by banging objects together, use body movements, or taking an adult's hand
• demonstrate anticipation of social games (e.g., peek-a-boo, song/finger plays)
• use of representational gestures such as waving goodbye and imitating clapping
• demonstrate shared attention by showing and giving objects

• request by looking at the object, then the adult, and then the object
• request actions by giving an object to an adult for help
• demonstrate the functions of objects such as brushing hair with a brush, putting on a hat, or stirring with a spoon
• point to objects or events for shared attention

• protest by shaking head for “no"
• request by reaching while opening and closing hands to obtain an object
• point to get someone to do something (e.g. open a door, carry to another room)
• take the hand of an adult and guide a hand or body to do something (e.g. take adult hand and put it on stomach to get tickled).
• demonstrate actions such as smacking lips to indicate wanting something to eat
• share attention by pointing to objects upon request (e.g. “show me the ball” or “Where’s the doggie?”)
• request information by pointing at pictures or objects with the expectation that an adult will name it

• seek attention through “showing off” (e.g. sticking out tongue, making funny faces, making sounds to get a laugh, and performing fingerplays such as patty cake)
• use representational gestures such as shrugging shoulders or putting hands up to indicate “all done” or “where did it go?”  
• blow kisses, signal “shhh” with fingers to lips, nod with a “yes,” pretend to sleep, and use conventional gestures of excitement (e.g. high five).
• share attention by clarifying verbal messages with gesture (e.g. point to an object he/she has attempted to verbally label)

Watch for the ways your child is communicating with you via gestures, or start to encourage gestures as an "in road" to further development of social communicative interactions.

As always, feel free to contact us at Autism Journeys with any questions or concerns!

Dawn

Pairing: Your best relationship with a child

I've been thinking a lot lately about a concept called "pairing".  This is the process of "pairing" yourself with reinforcement so that a child or learner regards you as a positive experience in his or her life.  Before placing instructional demands on a learner, a trusting and rewarding relationship must be established.  Best results can only be achieved when a child enjoys spending time with you!

Ways to do this:

--- Start with FUN!  Find what is reinforcing to the child and supply it!, with no expectations.  Best of all is to find what is fun (or funny) to the child in play -- tickle, chase, fall over (yes, sometimes you being the clown is hilarious and endearing!!)  Is there a favorite song or comforting tune the child prefers?  Maybe it's a tangible item- if the child loves goldfish crackers, be the one who has them, if the child is fascinated by spinning objects, have the best ones!  Be the bearer of all good things!

--- Be in control of the reinforcing item or activity, so that the child has to go through you to get it.  (Examples, you have access to desired treats and entertainment, toys are out of reach, you play the most fun games like tickle, airplane, or I gotcha)

--- Do not supply or offer reinforcement if the child is engaged in any problem behavior (you don't want to reinforce the wrong behavior).


How do you know if you are "paired" with a child/learner?  Simply put --

    Does the child approach you or avoid you?

Hopefully, he or she runs to you with excitement!  But if not (and it can take time), keep working on being a positive, fun, rewarding addition to the child's life.

Dawn Gummersall
Speech/Language Pathologist

Building Communication Around Routines

The WHY of Communication 


There are a number of reasons why a child might use communication. Two very important and also very different reasons are:

to regulate others and get needs met

to share attention and experiences with others

For children with autism, while both of these communication functions may be difficult to learn, the second one is the most difficult. Our goals for communication training for children with autism include helping them increase both the regulatory function of communication and also increase their motivation and understanding of using communication in more purely social ways. We hope to help them realize that they can share experiences with others, that it is fun to do so, and that communication is a part of this sharing of experiences.

Why Use Routines? 


Routines are of high interest to children with autism. Learning and using routines are learning strengths. They like the predictability of routines and, left to their own devices, often establish their own rigid routines and become very upset if they are disrupted. By establishing a positive routine, and then disrupting it, we create an incentive for the child to communicate in order to re-establish the familiar routine.

Joint Activity Routines 


A joint activity routine is a powerful teaching tool for children with communication disorders. This term describes a routine in which the child and the adult engage in a meaningful activity together and communicative behaviors are taught within the routine of the activity. 

Key elements of Joint Activity Routines

·      They occur in a meaningful and functional context (such as a play routine, a bathing routine, etc.)

·      They use the child's interests and strengths.

·      They are social (involve 2 people) at the child's level of understanding (ranging from parallel, to cooperative, to turn-taking, to interactive)

The adult role is to:

set up the environment and introduce the activity

add visual supports to the routine (such as pictures, objects, print words)

repeat and establish the routine, and then

wait -- and cue the child with the visual supports as needed to continue the routine

Adapted from:  Susan Boswell, 
Division TEACCH, www.teacch.com

Another resource puts it like this: “Choose a routine that’s easy to repeat and that your child enjoys.  It could be a people game, a song, a rhyme, or a routine you’ve created.  Once your child is familiar with the routine, you can use it to SPARK an interaction.

SPARK

·      --Start the same way each time

·     ------- Plan your child’s turn.

·     -------------- Adjust the routine so your child can take his turn.

·   -----------------------   Repeat the same actions, sounds and words each time.

·     ------------------------------- Keep the end the same."

from:  It Takes Two to Talk, Jan Pepper and Elaine Weitzman

We Are a Team!

A team approach, along with early diagnosis, offers the best outcome for a child with autism. At Autism Journeys, we are truly a team! Our team includes a psychologist, a licensed mental health counselor, a speech/language pathologist, an occupational therapist, intervention specialists in both behavioral and development treatments, and intervention aides trained in implementing programs designed by our specialists.  We work together on a consistent basis, ensuring that all team members are "on the same page", and that the knowledge and skills of each team member are incorporated into each child's treatment plan.  This results in an intervention program designed for each individual that ensures the highest possible outcomes. 

Rest assured, that with our impending changes, this philosophy will not change!  We will be individually in your homes providing services, but will have conferenced and consulted with all team members regularly, so that intervention is consistent, integrated, and of the highest standards.

CHANGES!!!

Dear Parents & Clients,

We, at Autism Journeys, have big changes on the very near horizon.  We have decided to take our services to you!  As of November 1, 2012, we will be transitioning to a home/community-based program.  We started our company on this model and had incredible results.  We have loved having a center in which to provide our services, but economically, the overhead costs have surpassed the benefits. We sincerely want to be able to provide our high quality services to a wider population. 

How will this work?

We will now begin doing all of our services in the client’s home.  We may also schedule sessions in community settings as appropriate.  There are many benefits to home-based intervention:

·      Skills are learned in the environment in which they most typically occur, contributing to improved generalization (being able to use learned skills in multiple and natural environments).

·      When we are in the home, we can observe and experience a client’s behaviors, needs, and strengths “in the moment”. By seeing what happens in daily activities, we are better able to plan effective intervention.

·      Being in the home can lead to better communication between providers and family members.  Caregivers can ask questions and learn strategies right away.

Rest assured, Autism Journeys will continue to offer a multi-disciplinary, collaborative approach.  However, how we structure our fees will change for anyone currently receiving Individual Development Plans (IDP). 

With these changes, we are also progressing toward being better able to help families get services covered by insurance.  Thanks in large part to dedicated and persistent families, most states now require some form of autism insurance coverage.  Unfortunately, Utah is not yet among them. Some families in Utah are already getting their insurance provider to cover services. Many families with out-of-state providers may already be eligible!   

We at Autism Journeys have decided to become pro-active in helping break down the insurance coverage barriers here in our state.  Adjusting our services and billing procedures puts us “in line” for autism coverage, if and when Utah becomes a covered state. 

Thank you in advance for your flexibility and understanding as we undergo this change.  Please call or talk to your provider/s about any questions or concerns.  Also please talk to your provider/s ASAP about any scheduling adjustments that need to be made.

Executive Functioning

Our children’s, or even our own, actions and behaviors often get attributed to a variety of things. Some of which may be accurate explanations, but often times we misdiagnose the cause. And as a result, the chance of success in changing these behaviors is significantly decreased.

While we may not be able to pinpoint the origin of all behaviors, there are some behaviors that we are increasingly becoming more aware of. Some of which are behaviors related to executive functioning.

Now ask yourself:

Does your child put his/her homework in their backpack, but somehow it never gets turned in? Do they often act on impulse before thinking? Is their backpack full of loose papers? Are they missing assignments? Do they have an abnormally hard time picking-up messes or cleaning? Is it difficult for them to make choices?

Or

Do you tend to start tasks but not finish them? Is your personal space typically disorganized? Does it take you significantly longer/shorter to complete tasks than you had anticipated? Do large projects overwhelm you? Do you have a hard time adjusting to change?

If you’ve answered yes to any of the above, then it’s probably a good idea to become more familiar with executive functioning, and how it may be impacting your life.

So, what is executive functioning?

The formal definition:

“A set of processes that all have to do with managing oneself and one’s resources in order to achieve a goal. It is an umbrella term for the neurologically-based skills involving mental control and self-regulation.” (Cooper-Kahn, 2008)

In other words, executive functioning is what helps a person “function” in day-to-day life.

What’s involved?

Generally speaking, there are many skills involved in executive functioning, each of which plays a crucial role in contributing to a person’s life, career, and academic success. These skills include:

·      Planning

·      Organization

·      Prioritization

·      Inhibition

·      Emotional regulation

·      Time management

·      Flexibility

·      Persistence/follow-through

·      Working memory

·      Attention shifting

·      Self monitoring (metacognition)

A person with good executive functioning tends to perform these skills well. They are likely goal oriented, persist at tasks, monitor and adjust his/her behavior to be more efficient, are on top of work and schoolwork, and organized.

A person with poor executive functioning, or executive dysfunction, does not seem to have much success or ability to perform well with these skills, regardless of motivation or effort. These individuals might appear disorganized, emotional, forgetful, lost, or sometimes even lazy. They tend to set goals, but can’t seem to reach them. They often are missing assignments and behind at work. In general, they just seem to lack the ability to follow-through.

Anyone can have executive functioning deficits, or executive dysfunction, however it is a very common occurrence in individuals with Autism Spectrum Disorders, ADD/ADHD, and as well mental disorders and syndromes.

If someone performs some but not all of these skills well, do they have executive dysfunction?

Not necessarily. Most of us tend to be better at some executive functioning skills than others. Few of us are likely good at them all. A key difference between those with executive dysfunction and the rest of us is that those with real deficits in these areas really just can’t seem to get it right no matter how hard they try.  In fact, they may not even have the ability to come up with any solutions.

Is there a way to tell the difference?

Yes, there are a few ways that may help differentiate whether or not these problems are a result of real executive functioning deficits or something else. A couple of initial identifiers may include 1) attempts to improve the problems aren’t proving successful, 2) reinforcement and motivation don’t seem to work, and 3) there seems to be little if no improvement over time.

From a clinical and more diagnostic perspective, evaluations from a mental health provider can be performed to assess executive functioning.  These evaluations are able to identify and break down the specific areas of deficit.

Why it matters:

Real executive functioning deficits, or executive dysfunction, can greatly impact a person’s day-to-day and long-term quality of life. If an individual is not able to effectively perform tasks and work through routine obstacles, the chances of being successful in academics, career, and life in general can be greatly decreased. It is for this reason that specific deficits be identified and addressed appropriately in order to provide the individual the opportunity to reach their greatest potential.

What to do if you suspect a problem:

If you suspect a problem there are things you may want to do: 1) try some of the strategies listed below. 2) Communicate with teachers, supervisors, service providers, etc., to gather as much in formation as you can about the individual and what is going on in various environments. 3) If the problem is significant contact your mental health provider to discuss a possible evaluation to further assess the problem as well as information on additional support strategies.

Strategies for intervention:

Depending on age and developmental level there are various interventions and strategies that can be used as supports as well as for skill building. Some of these interventions and strategies include:

·      Step-by-step instructions for completing tasks

·      Visual organization aides, such as graphic organizers

·      Lists and checklists

·      Break up work into smaller pieces

·      Written as well as oral instruction

·      Minimization of clutter

·      Specification of expectations

·      Use of watches, timers, and alarms

·      Calendars and schedules

·      Identification of short and long term goals

·      Regular self reflection and evaluation

·      Specific vs. open-ended questions, expectations or requests

·      Reduction of distractions

·      Use of 1 and 2 vs. multi-step directions

·      Slowly increasing expectations and demands over time

·      Plan ahead when possible

·      Positive reinforcement

·      Behavior tracking of various interventions

·      Constant and open communication

To wrap it up:

Executive functioning skills are keys to success in almost all areas of our life. Before dismissing someone as being lazy or disorganized, understand that there may be something more going on. It is important to find strategies that work specifically for the individual, as we all are different and what works for one, may not work for another.

For more information on executive functioning, check out these resources:

Late, Lost, and Unprepared: A parents guide to Helping Children with Executive Functioning. By: Joyce Cooper-Hahn, Ph. D. and Laurie Dietzel, Ph.D.

Executive Skills in Children and Adolescents: Practical Guide to Children Assessment and Intervention. By: Peg Dawson and Richard Guare

Smart but Scattered. By: Peg Dawson and Richard Guare

Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction. By: Mary V. Solanto

Thoughts about Medication in the Treatment of Autistic Spectrum Disorders

Natalie Roth, Ph.D.

Licensed Psychologist

Autism Journeys

It can often be confusing to sort through the numerous intervention options for Autistic Spectrum Disorders.  Possibly one of the more challenging decisions for parents with children that have ASD’s is whether or not medication is an appropriate addition to a treatment plan.  In my experience, most parents feel a profound sense of responsibility in making this choice for their child.  They often express concern about their child’s comfort and safety, and I regularly hear parents talk protectively about wanting to maintain their child’s unique personality, even if his/her behaviors can sometimes be problematic.  At the same time, parents want to maximize their child’s ability to make use of and develop the skills they have so that they are best able to function at school, at home, and in their community. Navigating this decision often requires parents to carefully balance the potential benefits of medication use against the potential drawbacks.  This weighing of options is not always easy as neither the benefits nor the drawbacks are not always immediately apparent.  As I’ve talked with parents who have been through this process these are a few points that I’ve found to be helpful:

·      Keep in mind that there are no medications that treat the core symptoms of Autistic Spectrum Disorders directly (those being delays in speech/communication, qualitative delays in social functioning, and patterns of repetitive/stereotypic behavior).  Medication can be very helpful in reducing behavior outbursts, alleviating anxiety, and lessening obsessive thinking or compulsive behavior, for example.  This, in turn, can lead to an improved ability to manage some of the challenges of the core symptoms, but it will not alleviate them altogether.  It’s important that medication trials be undertaken with realistic expectations.

·      Appropriately, most doctors prescribing to children will begin with a low dose of medication to determine whether or not it is well tolerated.  However, this low dose may not be within a therapeutic range for your child initially, and I encourage parents to prepare themselves to be patient as they work with their doctor to determine the right dosage. 

·      Children with ASD sometimes respond differently to medication than is typical.  It is important to work with a prescribing doctor who is open to communicating with you about your child’s individual response.  As a parent, you should feel supported by your medical providers in your attempt to advocate for the appropriate dose/timing of any medication.  You will be the person who is most sensitive to both positive and negative effects of medication and this perspective should be valued.

·      A doctor will describe the side effect profile that accompanies medication use.  While potential side effects of medication should be considered, I also frequently advise parents to think through the “side effects” of not treating a behavioral/emotional issue that might benefit significantly from medication.   Research with children who have ADHD, for example, suggests that those children effectively treated with medication were less likely to become involved in drug/alcohol use because their symptoms were managed.

·      Medication for any developmental disorder is most effective when it is part of a more comprehensive treatment plan.  Medication can have important benefits, but shouldn’t take the place of therapies designed to teach skills.

·      It can be helpful to seek out a doctor or a child psychiatrist who has experience treating children with Autistic Spectrum Disorders.  Experience with how certain types of medication affect particular symptoms, how medications work together, and how children with ASD’s respond differently to medications can be invaluable.

·      I encourage parents to identify (with the help of their doctor and therapists) 2 or 3 particular behaviors that they are trying to address with medication.  Before starting a medication trial, I suggest that they keep some simple data on how often they observe the target behaviors on a daily basis (or during certain times of the day).  Once medication has reached a therapeutic dose, continue to keep data on the occurrence of the behaviors during the same time frame to give them some concrete way to monitor its effectiveness.

For those who are interested in the types of medication that are most frequently prescribed for children with Autistic Spectrum Disorders, the following information is adapted from information provided by the National Institutes of Health:

Medication and Autism

Medications are often used to treat behavioral problems such as aggression, self-injurious behavior, and severe tantrums, that keep the person with ASD from functioning more effectively at home or school. The medications used are those that have been developed to treat similar symptoms in other disorders. Many of these medications are prescribed "off-label." This means they have not been officially approved by the FDA for use in children, but the doctor prescribes the medications if he or she feels they are appropriate for your child. Further research needs to be done to ensure not only the efficacy but the safety of psychotropic agents used in the treatment of children and adolescents.

Anxiety and depression. The selective serotonin reuptake inhibitors (SSRI's) are the medications most often prescribed for symptoms of anxiety, depression, and/or obsessive-compulsive disorder (OCD). Only one of the SSRI's, fluoxetine, (Prozac) has been approved by the FDA for both OCD and depression in children age 7 and older. Three that have been approved for OCD are fluvoxamine (Luvox), age 8 and older; sertraline (Zoloft), age 6 and older; and clomipramine (Anafranil), age 10 and older.4 Treatment with these medications can be associated with decreased frequency of repetitive, ritualistic behavior and improvements in eye contact and social contacts. The FDA is studying and analyzing data to better understand how to use the SSRI's safely, effectively, and at the lowest dose possible.

Behavioral problems. Antipsychotic medications have been used to treat severe behavioral problems. These medications work by reducing the activity in the brain of the neurotransmitter dopamine. Among the older, typical antipsychotics, such as haloperidol (Haldol), thioridazine, fluphenazine, and chlorpromazine, haloperidol was found in more than one study to be more effective than a placebo in treating serious behavioral problems. However, haloperidol, while helpful for reducing symptoms of aggression, can also have adverse side effects, such as sedation, muscle stiffness, and abnormal movements.

Placebo-controlled studies of the newer "atypical" antipsychotics are being conducted on children with autism. The first such study, conducted by the NIMH-supported Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was on risperidone (Risperdal). Results of the 8-week study were reported in 2002 and showed that risperidone was effective and well tolerated for the treatment of severe behavioral problems in children with autism. The most common side effects were increased appetite, weight gain and sedation. Further long-term studies are needed to determine any long-term side effects. Other atypical antipsychotics that have been studied recently with encouraging results are olanzapine (Zyprexa) and ziprasidone (Geodon). Ziprasidone has not been associated with significant weight gain.

Seizures. Seizures are found in one in four persons with ASD. They are treated with one or more of the anticonvulsants. These include such medications as carbamazepine (Tegretol), lamotrigine (Lamictal), topiramate (Topamax), and valproic acid (Depakote). The level of the medication in the blood should be monitored carefully and adjusted so that the least amount possible is used to be effective. Although medication usually reduces the number of seizures, it cannot always eliminate them.

Inattention and hyperactivity. Stimulant medications such as methylphenidate (Ritalin), used safely and effectively in persons with attention deficit hyperactivity disorder, have also been prescribed for children with autism. These medications may decrease impulsivity and hyperactivity in some children, especially higher functioning children.

Several other medications have been used to treat ASD symptoms; among them are other antidepressants, naltrexone, lithium, and some of the benzodiazepines such as diazepam (Valium) and lorazepam (Ativan). The safety and efficacy of these medications in children with autism has not been proven. Since people may respond differently to different medications, your child's unique history and behavior will help your doctor decide which medication might be most beneficial.

I’m continually amazed at the thought and effort that parents dedicate to their children with ASD’s.  In many cases, medication can be an option worth considering in the context of a more comprehensive treatment plan.  Best wishes to all of you who are continuing on the journey to understand and provide the best for your children.