Expert: Dr. Sharon A. Mitchell - 4/20/2011

Question
Good morning. I am a single mother who is very confused. My son was diagnosed with epilepsy when he was 7 1/2 months old. He has been seizure free since 2000 without being on medication thank goodness. However, as he grew old, I noticed he would use signs to speak and not talk. He finally begun talking late but even now, he gets speech therapy at school. He does not always make sense and gets fixated on particular things. Almost like an obsession. He moves his head in a rocking motion all the time and has trouble comprehending. They tested him for Autism but said he has Asperger's Syndrome. As I research it, I did find he had alot of the signs. He is not medicated, a very loving and kind child, but likes to be along alot. Like he is in his own little world. I don't take him to the doctor cause all they want to do it medicate him. Is it wrong that I don't take him in? He doesn't need medications. I think just patience. But what I want to know is how do I get him to stop being on fixated on one particular thing. When he gets fixated on something. he becomes obsessed. They say he has OCD, Obsessive Compulsive Disorder. I just need some advice. Thank you.

Answer
Hello Deanne,

I see how some of this is confusing.

Often with kids with an autism spectrum disorder, there is nothing simple about their profile of strengths and challenges. You mention that initially your boy was diagnosed with epilepsy, a seizure disorder. It is not unusual for kids with autism to experience seizures at some point in their life.

What does surprise me is that your son has a diagnosis of Asperger's. One of the criteria for Asperger's is that the child did not have a delay in acquiring language; you say your little boy was late talking.

Asperger's though falls under the umbrella term of autism spectrum disorders (ASDs). Rather than the specific label within the category of diagnoses, what is important is your son's unique pattern of strengths and challenges. Language development has been identified as an area of need for him and he is already receiving speech therapy.

Becoming fixated on objects, patterns or routines is not unusual for kids with ASDs. For some children, this is not something that interferes greatly with their lives - they may leave their special interest when prompted and the obsession does not get in the way of their day-to-day activities. For others though, this obsession can take valuable time away from his learning experiences at school and at home. A rigid adherence to routines or ways of doing things can limit flexibility; few of us have lives that can be run to exact schedules. Sometimes these obsessive or OCD tendencies become more pronounced in adolescence. An increased focus on obsessions can further isolate a child and it sounds like your young man already prefers to spend time alone.

Since medical people have suggested to you the possibility of medications, it is my guess that they may be targeting potential medications at these fixations. I understand your reluctance to try a medication on your son. As parents, this is generally the last thing we will want to try, only after we have exhausted other strategies and the behavior continues to get in the way of the child having a happy, productive life. Most physicians would agree with that. The degree to which your son becomes obsessed may be sufficient that his doctor thinks it is worth a trial of medication. There are medications that can lessen the severity of the OCD, helping him to more easily let go of his obsessions, move on to other things and be more open to learning.

No, it is not wrong that you don't take your son to the doctor. But, I do think it is worth listening to the opinions of others. Your son is in school. What do his teachers and the special education experts in your school say? Do they feel that his obsessions are interfering with his learning? Are the obsessions becoming worse? You could ask for their assistance with this. They could summarize for his doctors the behaviors they observe at school and how your son responds when they attempt to redirect him.

Sometimes our idea of medication is of a child who is a zombie. You do not want that; his teachers do not want that and most certainly, his doctor does not want that. You want your child calm, relaxed, happy, and open to learning. If he's over-medicated, he will not be in a position to learn and grow. If he is enslaved by his obsessions, he also will not be available to learning.

Prescribing the proper medication, unfortunately is not an exact science. Everyone's body responds a little differently to such medications. The best a doctor can do is to take an educated guess, based on the child's age, size, symptoms and the research for such conditions. They your physician relies on caring parents such as yourself to report back how the medication is affecting your child.

This is not a fast process as you may need to wait a couple weeks to see the affect it is having. Based on your feedback and that of his teachers, the dosage may need to be decreased or increased, the time the pill is given may need to be altered or a different medication tried. Sometimes a combination of pills work best to help the child be at his optimal state.

Trying a medication is not a forever decision. A month's trial might give you an idea whether or not if makes a difference, as long as you are in contact with the prescribing doctor, giving him the required feedback to tailor the medication for your child.

Without meeting your boy, I cannot offer any opinion on your medication issue. I understand your reluctance but on the other hand I have seen children helped tremendously by the correct medication. I would suggest that you talk further with the professionals who know your boy.

Best wishes,

Dr. Sharon A. Mitchell
www.autismsite.ca