Expert: Catherine Ridenour - 11/20/2008

Question
I am a father. My son (age 14, weight 47Kgs) has been diagnosed as having Autistic Spectrum Disorder (though some say PDD NOS, some say Asperger Syndrome). His speaking ability / intention was little. But we observed that when he wanted to speak himself he could do that correctly. From about a year before (Dec 07) we saw he is speaking to himself, or mutering to nobody staring at a distance wall or corner. From April 08 Risperidone 1 mg started. Initially it was somewhat better but during Aug-Sep the self talking went up. Dr. told us before that Risperidone will never reduce the self-talking to zero but it will reduce it. If it does not work it can be stopped after 6 months. Our impression that it did not really help him. So we thought to withdraw the medicine slowly and reduced the doze to 3/4 mg first 8 days and then 1/2 mg last 3 days. We observe that self talking has been enhanced considerably. Now another doctor wants to enhance the doze to 1.5 mg and even more if required. We are highly confused and hesitant in what to do. In one side psychiatrists say that medicine helps only 10-15% in Autism, while other doctors asking to enhance doze. We heard that Risperidone has lot of side effects. Please help. I am not sure if what I wrote is clear, but if you like to know anything else pl. ask me. I am eagerly looking forward to hear from you. Thanks a lot and best regards.


Answer
Hi Subhrangshu,

I am only a parent, not a doctor, so what you get here is my personal opinion. (I have to say that.)

Risperidone does have some very unpleasant side effects. I am not sure that it is worth the risks just to reduce how much he talks to himself, or no one you can see. Many kids on spectrum have brains that are not wired to handle language well. This may be his way of processing information. It may actually be a coping mechanism.

I think you can rule out Asperger's syndrome. One of the defining characteristics of this disorder is that the child is very talkative to others. They talk very young and have huge vocabularies.

If this were my son, I would wean him off the medicine (under careful medical supervision) and seek out good speech and occupational therapy for him. Expert therapists can work on drawing him out into the world.

It is my belief that any behavior that is merely annoying and not hurting anyone should be ignored. Calling attention to hand flapping, self-talk and other such things only reinforces them as attention-getting methods. Instead, pay attention to the behaviors you want to increase. Most of these kids have a few things they are very interested in. Use this passion to reward desirable behavior.

Try to find a support group near you where you can talk to other parents and get ideas about what has worked for them. Each child has unique needs and you have to get creative.

Best wishes,
Catherine