mmham

my cild is on carbamezapine 1200mg he has epilepsy as well as autism. he is recently showing very aggressive behavior specially when he wakes up. the doctor has added risperidone 1mg three times as well as propanolol 10mg three times but he is still not improving. Can u help and oblige?
a desperate mother

[Jason C Bourret, Ph.D., BCBA-D]

We're getting a number of questions regarding the effects of medication on problem behavior in children diagnosed with autism.  In a nut shell, medication has been shown to be effective in some cases.  I would advise you to make sure that you are working with a doctor who has experience proscribing these medications for children with diagnoses similar to your child's.  Make sure you are comfortable with the way that the meds are being proscribed, monitored, and evaluated.  If you aren't seek a second opinion.  I would also advise you to seek a qualified behavior analyst in your area.  This should be someone who is a board certified behavior analyst and has experience treating problem behavior in children diagnosed with ASDs.  A psychotropic medication should be used in conjunction with systematic teaching procedures designed to help your child learn more effective ways of tolerating and handling problematic situations.  An answer that I gave in a previous thread is copied below in case you might find it helpful.


It is not uncommon for children diagnosed with an ASD to emit severe problem behavior.  

Regarding the medication, make sure that you are working with a proscriber that you are comfortable with.  The doctor supervising the use of the medication should be explaining to you exactly what a medication is targeting for your children, how the effects of the medication will be measured, and what the overall plan is for determining if the medication is successful.  For example, the plan might be to target the child’s aggression with risperidone, starting at a certain dose and titrating the dose upward to a certain point until either a clinically significant effect is observed (in which case, you’re convinced that the child is on the right med at the right dose) or a clinically significant effect has not been observed (in which case, you’re convinced that the child is not on the right med and the med should be removed).  Make sure that you’re clear on the plan, data collection system, and reasons why decisions are being made.  If you’re not happy with the proscribing doctor, seek a second opinion.  Look for a physician is one that has experience proscribing psychotropic medication to individuals diagnosed with ASDs.

Regarding the problem behavior, although medication can, in some cases, be effective in suppressing problem behavior in children diagnosed with ASDs, the intervention that has been shown to be most reliably effective is applied behavior analysis.  Over 20 years of rigorous experimental evidence has shown that children can learn appropriate alternatives to severe problem behavior given the right teaching arrangement.  Behavior analytic interventions typically involve identifying the situations that are most problematic for a child and the things that are most rewarding and systematically teaching a child more appropriate ways of handling problematic situations and of obtaining reinforcing things and events.  These interventions are individualized to the needs of the particular child and, with the right services, the prognosis for treatment of severe problem behavior can be quite good.  I recommend that you also look into identifying a board certified behavior analyst who has experience treating behavior problems exhibited by children diagnosed with ASDs.  You could start at the certificant registry on the BCBA website: http://www.bacb.com/