If you have a child who is autistic, let's talk about what that could look like.
We know autism is a spectrum ranging from verbal to nonverbal, and everywhere in-between.
As a parent, I would imagine that means you are managing your communication with your child carefully to avoid meltdowns. Walking on eggshells, not making unnecessary noises that may trigger them. You are constantly helping them process a world that is too overwhelming and chaotic for their breaks.
As a parent, that is exhausting. I know. Raising a neurodivergent child, particularly if they display Pathological Demand Avoidance, is hard. It takes every ounce of your energy. Your child most likely struggles with regulating themselves, so you are offering your own nervous system to them for co-regulation.
At what point do you consider medication? Parents start medication for their kids as young as two or three in some cases. Sometimes that is out of desperation in watching their child suffer and not be able to sleep.
Autistic children often do not create and process melatonin, the chemical responsible for sleep, in the same way as neurotypical folks. What does that mean? It might mean that they go to sleep really late. Or that they don't sleep much. That doesn't mean that their body doesn't need sleep -- they are still exhausted. But they can't sleep. Beyond melatonin, there are a lot of other reasons such as overstimulation, sensory processing differences, and brain structure that impact the ability of a child to sleep.
When we don't sleep, we can become irritable, aggressive, moody, and just plain dysregulated in every realm of life.
Sleep is one of the main reasons that parents seek medication for their kids, and this is something that can be really beneficial. Melatonin in baby dosages (0.25mg, 0.5mg, 1mg up to 3mg) for children can be tried first. Magnesium powder can be mixed into juice before bed to help with sleep and giving the body some rest. If that doesn't work, yes, it makes total sense to seek psychiatric support to help your child (and yourself, let's be honest).
Aggression, irritability and meltdowns are reasons that parents seek psychiatric help for their kids. This is also valid. Before medication is considered, consider the cause of the meltdowns and aggressive episodes. Is this because they are struggling with a transition (going from class to lunch, going from school to home), an unexpected change (a stop at the gas station when it wasn't mentioned in the plan), sensory overwhelm (a lot of noise, movements, lights in a room), social misunderstandings (feeling someone is being rude to them, taking something from them), or a change in their routine.
Stop and stay quiet and still. Pay attention to the noises around you. There are so many small noises that our brains filter out. Their brains do not do that. Their brains take in everything at once. It is overwhelming. Headphones in public spaces or at school can make a world of difference in keeping kids from becoming overstimulated over a period of time.
Do they have accommodations at school? Are they actually using them if they have them? Maybe try noise-cancelling headphones for the day instead to see if it makes a difference.
Do they need more warning with transitions? Maybe a visual schedule? Do they need a specific routine that can help give them more predictability? Do they need a sensory "safe place" or time after school to wrap themself in a weighted blanket cocoon and unwind?
Do they need OT or PT? Are those services in place?
Is their school right for them? Is the school maybe just not the right fit and causing anxiety, poor self esteem, and meltdowns? Do you need to tour other schools and consider other options?
If you need help with school accommodations, we are here to be on your team.
If everything is in place and your child feels out of control, yes, absolutely medication can be an option.
Should you medicate hand-flapping, nail-biting, jumping or other repetitive behaviors? No. These are stims - self stimulatory behavior. These are helping them to regulate their nervous systems. Let them stim. Yes, it looks different. Yes, people may stare at you. But you know what, this is your kid -- let them stare. Do not be their first bully -- be their protector. Will stims decrease with medication? Sometimes; if a nervous system is more regulated, they might be less likely to need stims.
Should you hope that eye contact improves with medication? No. Should you consider therapies such as ABA to "improve" eye contact? Autistic adults who have gone through this say no. It was not beneficial, and in fact more overstimulating and in many cases, traumatic for them. Eye contact is something we expect socially which has nothing to do with a person's ability to listen.
If you do move forward with medication for your child, know that medication is not bad. Medication can be lifesaving. Medication can improve a person's quality of life tremendously.
We have incredibly neurodivergent affirmative providers here who will be happy to discuss options, including both pharmacological and non-pharmacological, with your family if you live in Arizona.
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