Psychopharmacology: Should I Use Medications for my Child?

There are numerous ways that a child might first present to a child psychiatrist. Most patients who present to my office are referred by pediatricians or therapists because the parent or the professional suspects that the child has autism spectrum disorder (ASD). Sometimes, parents bypass the primary care physician and present directly to whomever it is that they perceive to be the expert on ASD: this could be a developmental pediatrician, child psychiatrist, child psychologist, or child neurologist. Other times, they present their child to me as a “last resort” because they do not know what else to do and are reluctantly considering medications. These parents may have been in denial, avoiding diagnosis altogether, or their child may have already been diagnosed with ASD and they have been avoiding a discussion of medications. The first question I expect that most parents would ask is, “Can medications cure autism?” However, most parents seem to already understand that the answer to this is, “No.” Although medications cannot cure ASD or even technically treat the “core symptoms” of autism, they often do treat some of the most problematic and impairing symptoms associated with ASD. For example, to the parent who is desperate for relief from severe tantrums (“meltdowns”), aggression, irritability, and/or self-harm behavior, an atypical (second-generation) antipsychotic medication can seem like a miracle despite the fact that it is not curing the underlying autism. Although we will discuss atypical antipsychotics in detail further in this chapter, briefly they are a class of medications approved by the U.S. Food and Drug Administration (FDA) that help to treat tantrums, aggression, and other symptoms associated with ASD. A multitude of impairing symptoms and comorbid disorders are associated with ASD, and many of these symptoms can be treated with medications. I will mention studies throughout this chapter so that it is clear that I am not speaking only from my personal and professional experience but also from real data.