Imagine the moments in your life when you were the most nervous. Maybe you faced auditioning for a big part, or asking your spouse to marry you, or owning up to doing something wrong. Remember the gnawing feeling of fear? Remember the physical tension and jitteriness you felt? Well, it’s possible that your son or daughter on the autism spectrum may be in a similar state of anxiety a majority of the time. Many autistic children, especially upon reaching puberty, are ruled by fear.
Temple Grandin, Ph.D., an autistic woman who is an author, professor, and public speaker, has taught us much about the plight of autism. In various books and public forums she has described her teenage years as being “in a constant state of anxiety.” She compares her continual sense of fear and panic to how a person might feel just prior to giving a dissertation. “Socializing with other people and other activities were difficult when my heart was pounding and I had a lump so big in my throat that swallowing food was sometimes difficult,” she explains in the book, Adolescents on the Autism Spectrum, by Chantal Sicile-Kira and Temple Grandin.
The road to Temple’s eventual success was finding the right medication and the right dosage. Because her panic attacks increased as she matured, she relied heavily on the help of her anti-depressant. She explains that the need was due to “faulty biology” associated with her autism. She has continued to take her antidepressant for several decades, and reports that it makes her “stable.”
There are dangers to giving young children antidepressants, and even with teens and young adults, medication should always be a last resort. However, autistic teens who are overwhelmed by panic attacks and anxiety may do well with the low-dose principal of using the smallest amount of medication that works. Prozac is commonly used in low doses for autistic teens, and many who were battling anxiety and rage were helped immensely.
How do antidepressants help?
We know that the brain “wiring” of an autistic person is somewhat atypical. We are seeing that, in autistic people, nerve fibers which link various parts of the brain are malformed. However, it isn’t clearly understood whether these malformations cause the autism symptoms, or whether the autism, as it limits certain cognitive abilities, causes the malformations. These brain differences may mean that levels of serotonin, dopamine, and noradrenalin, which help create a feeling of well-being, are off-balance. In theory, anti-depressants known as selective serotonin reuptake inhibitors (SSRIs) delay natural enzymes from destroying these neurotransmitters, creating higher numbers of them in the brain. The most commonly prescribed antidepressants with the lowest number of side effects are Prozac, Zoloft, Paxil, and Lexapro.
Rules of Thumb for Finding the Right Antidepressant and Dosage:
- Start with an excellent doctor, who knows autism well and has a lot of experience with antidepressant therapy. Document your child’s symptoms of anxiety and fear, especially if his language is limited. Are you certain that anxiety is the main concern?
- Try a well-established, standard antidepressant which your child’s doctor has prescribed many times before. Use the lowest dosage recommended for your child’s age and weight.
- Do not mix medications or combine antidepressants because if there are side effects or if the medication isn’t working, you won’t know which to blame the negative result.
- Look for obvious, dramatic improvements in your child’s behavior and sense of well-being. If you don’t see a change, ask your child’s doctor whether he recommends a slight increase in the dosage or trying something new. If you switch medications, do it gradually and try a medication that works in a different way than the previous one. Don’t go back and forth switching medications numerous times. And it’s never worth medicating your son or daughter if you aren’t seeing very positive results.
Every child is an individual, and there is certainly no pill that will solve all the complicated issues associated with autism spectrum disorder. However, if your teen struggles with fear and anxiety, exploring the possible benefits of antidepressant therapy is certainly justified.
Kristyn Crow is the author of this blog. Visit her website by clicking here. Some links on this blog may have been generated by outside sources are not necessarily endorsed by Kristyn Crow.
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