Expert: Dr. Sharon A. Mitchell - 4/4/2007

Question
My 5 yr old is in special ed pre-k.  The teacher seems to think that he might have ADHD also, but hasn't been tested for it.  She seems to think that my son would excel with some medication.  She said that he probably would not have to be in spec. ed. if we could just him to calm down enough to listen.  My question is, is there any meds out there for Aspergers that could help him calm down.  I do not want him on Aderall, I know this, my best friend son took Aderall for 2 yrs and developed T.S from it.

Answer
There are several issues here.

First, the ADHD. Some kids with Asperger's also have a diagnosis of ADHD. Some don't receive a separate diagnosis, but some degree of attentional difficulties are very common in kids with autism spectrum disorders.

ADHD is a medical diagnosis, rather than an educational one. Teachers can often be very helpful in supplying the physician with observations that can lead to a diagnosis of ADHD.

Your school or your doctor may have checklists that they prefer to fill out that would paint a picture of how your son reacts, curbs his impulses and maintains appropriate levels of attention during the school day. A common one is the Conners Rating Scale although there are many others. The special education teacher in your school should have some suggestions for you.

Second. Not everyone has the same reactions to identical medications. Just because a friend's son had a certain experience with Adderall or any other drug does not mean that your child would react in similar fashion.

It may not be that the Adderall caused your friend's son to have Tourette's Syndrome. There is evidence that in people with a pre-existing condition, some medications (not necessarily Adderall) may bring out the symptoms or bring them on sooner than they might otherwise have appeared.

But if you are adamantly opposed to Adderall, there are quite a few other medications to choose from and kids with Aspergers do take them. A few of the medications that can have some positive affect on attention are Ritalin, Concerta, Strattera, Dexedrine and Cylert. They can have short-term, intermediate or longer acting (all day) characteristics. Only some of these fall under the family of stimulant medications, like Adderall. You can read more
information on these at:

http://www.keepkidshealthy.com/medicine_cabinet/adhd_medications.html

Although I have most definitely seen some children who benefited greatly from medication to help their attention, as parents, we're reluctant to give our kids medication unless it's absolutely necessary. Both you and your son's pre-k teacher want your son to be as successful and happy as possible. So, you and the school might want to try some other options before going the medication route.

Third. For some kids with autism spectrum disorders, their attention is hampered by the way their body processes sensory information. If certain senses are either over or under aroused, they will experience difficulty with self-regulation - managing their emotional reactions and their level of alertness.

Sensory strategies can have a positive effect on attention for some children. I've written some short articles on a few of the things you could consider at these URL's:

http://www.autismsite.ca/html/hands_in_pants.html

http://www.autismsite.ca/html/wiggles_in_desk.html

http://www.autismsite.ca/html/gym_and_music.html

Brenda Smith Myles has written an excellent little book called "Asperger Syndrome and Sensory Issues". You can take a look at it by pasting the following URL into your browser window:

http://www.amazon.com/Aspergers-Syndrome-Sensory-Issues-Practical/dp/0967251486/...

The Alert Program is one I really like because it teaches kids self-awareness and strategies they can learn to use themselves, rather than requiring an adult to always take the lead or manage their behavior for them. It can be done with individual kids, a small group or a whole class although at age five, I'm not sure your son would be able to internalize the strategies as well as would a child a few years older. Still, the book contains lots of strategies and analogies you may find useful (http://www.amazon.com/How-Does-Your-Engine-Run/dp/0964304104/ref=pd_bbs_sr_1/102...).

A couple other books I find useful are "Answers to Questions Teachers Ask About Sensory Integration"
(http://www.amazon.com/Answers-Questions-Teachers-Sensory-Integration/dp/19316150...) and "The Sensory Connection" (http://www.amazon.com/Sensory-Connection-Nancy-Kashman/dp/1931615217/ref=sr_1_13...).

While it's one thing to read and learn from books, the advice and guidance of an Occupational Therapist can be valuable if there is one available in your district. Talk to the special education people in your school about OT involvement and the possible benefits of trying things like weighted vests, weighted lap cushions, neoprene hugging vests, body breaks, etc.

Sensory strategies may have some beneficial effect, yet for some kids are only a part of the answer. The medication issue is something for you to discuss with your medical practitioner.

If you do decide on a course of medication, the school can be instrumental in providing you and your doctor with information on if the meds are having the desired effect. You and your doctor may need to adjust the dosage, the time of administration and which medication is most effective. You'll need the school's help because they see your boy in a structured setting with different attentional requirements than when he is playing at home. You and the teacher are on the same side - wanting the best for your boy.

Sharon A. Mitchell
www.autismsite.ca