The Parent's Guide to the Medical World of Autism: A Physician Explains Diagnosis, Medications and Treatments: A Physician Explains Diagnosis, Medications & Treatments - Softcover

Dr. Aull is a behavioral pediatrician who has been diagnosing autism spectrum disorders and treating patients on the spectrum for more than 30 years. He practices in Carmel, Indiana, a suburb of Indianapolis, where he resides with his wife. Dr Aull spent 24 years in a general pediatric practice, which aided him in being able to distinguish normal behavior from abnormal behavior in children and young adults. For many years, Dr Aull has spoken at ADHD and autism conferences about the milder forms of autism spectrum disorders and how they may be diagnosed and treated.

 
 
                This is the first book I have read where a wise, highly experienced doctor has discussed his use of medications on many different types of individuals on the autism spectrum. Medications, when they are used with a careful conservative approach, can help many individuals. A low dose of an antidepressant started in my early thirties stopped my non-stop anxiety and panic attacks. During my twenties my anxiety had become progressively worse. My nervous system was on high alert and vigilant for non-existent dangers.  I was like a vigilant antelope on the African plains constantly on the lookout for lions. The constant stress was destroying me and I was wracked with headaches and colitis. Within three days after taking an antidepressant my pounding heart, sweaty palms, and colitis almost completely stopped.  Antidepressants, when they are prescribed correctly, can work wonders for anxiety.  It is important not to give too high a dose.  Too high a dose may cause a person who has high anxiety to have insomnia and agitation.  They will feel like they drank 20 cups of coffee. 

In 2010, I learned why I had been so anxious.  A brain scan done by Jason Cooperrider at the University of Utah showed that my amygdala was three times larger than normal.  The amygdala is the brain’s fear center.  My nervous system had been in a constant state of fear.  I have been on dasipramine 50 mg/day for 35 years.  Since I am stable, I think the best thing to do is keep taking it. Autism is highly variable some individuals will have severe anxiety problems and others do not.

                I have several friends who are not autistic who work in design and a low dose of Prozac (fluoxetine) has controlled their anxiety and helped to prevent a return to an addiction to drugs and alcohol.  I do not have scientific evidence for this, but conversations at many autism meetings indicate that people on the autism spectrum, who are good at art or math, tend to have more anxiety than more verbal word based thinkers who often love history.


                Dr. Aull has an autism continuum that does not follow the DSM diagnostic criteria. It is based on his many years of clinical practices. He discusses low, moderate, and high functioning autism and low, moderate, and high functioning Aspergers.  It is best to view this as a continuum that ranges from the mildest autism traits to more severe.  Dr. Aull created his own autism continuum because it helped him prescribe the right medications. When you read this book, it is best to look at his different cases and see which ones are most similar to your child or student. When I read the cases he presented, he had relatively few cases on the most severe end of the autism spectrum. This would include older individuals who are non-verbal and may have other serious conditions such as epilepsy. This book provides very little discussion of anticonvulsant mood stabilizer drugs, which are often useful for anger attacks that “come out of the blue” with no stressful event preceding them.  This is another indicator that this book maybe most helpful for individuals who are either verbal or partially verbal. A doctor in Canada named Joe Huggens, has worked with the most severe non-verbal clients who have been kicked out of many programs due to severe meltdowns.  In this population, he found it was often best to avoid the antidepressants and use anti-convulsants, atypical antipsychotics and the beta-blocker propranolol which is a blood pressure medication. This book is essential reading for every parent who has a child who is either taking medication or thinking about the use of medication.

 

1. A medication should have an OBVIOUS BENEFICIAL effect.  When I took anti-depressants, it was like “wow!”  I’m a believer biochemistry.  The use of powerful antipsychotics such as Risperdal (risperidone) or Abilify (aripiprazole) as sleep aids or to make a child a tiny bit less hyper is a bad idea due to severe side effects. If the drug makes it possible to engage in more normal activities, then it is worth the risk.
2. Try one thing at a time.  Do not start a drug at the same time you start a new school or a special diet.  Space them apart by a few weeks so you can see what works.
3. Do not increase the dose or add another medication every time there is a meltdown or a problem.  Medication is only one tool in the toolbox for behavior problems.  In most cases, but there are some exceptions – one to three medications is usually sufficient for anxiety, depression, aggression, irritability or staying on task.
4. Be careful changing brands of generics.  This is especially important with time-release products.  Doses may have to be changed when the drug is obtained form a different vendor.
5. Too many powerful medications are being given to very young children who are under six.  A good basic principle is to be more conservative with medication in very young children.