Expert: Catherine Ridenour - 11/30/2006

Question
My 6 year old son has just been diagnosed at High Functioning Autistic. WE had thought it was Asperger's but I guess it is a bit more than that. I am just now starting down the road of treatment with him. He is in therapy, he is seeing a specialist at UCI and is about to start speech therapy. His school has good intentions but I'm afraid they are lacking in the knowledge department. He has been on Prozac for about 3 weeks. Initially, he was doing great, I and his teacher saw improvement almost immediately. During his 3rd week he started to have some bad days. It progressed to very violent behavior. I was told to stop the med for 1 day and start again the next at half dose. He has now been at half dose for about 4 days. He is calming back down a bit but still seems very easily agitated. The specialist suggested Risperdol. Telling me about what it can do I was ready to sign up. But after telling me about the diabetes related to the weight gain, the facial ticks, the growth of breasts, and the possibility of fever and muscle aches leading to a trip to the ER I am more scared and confused than ever. I am a single mother of two and he is my youngest. He is in desperate need of some kind of medication but I'm not sure what? Should I keep him on the lower dose of Prozac and see how that plays out? Should I try a different medication in the same family as Prozac? should go for broke and try the Risperdol? Do I have any more options? I can't have my son beating up all his kindergarten classmates, teachers, grandmother, and small animals but I don't want to endanger his well being. What can I do?! Any advise is appreciated and wanted. I feel alone in all this and very scared for my son.

Answer
Hi Casey,

Risperdol was only approved for autism very recently. I have no personal experience with it. My personal feeling is that it should be a last resort.

I would stick with the Prozac for at least 2 weeks and if that is not effective, try another anti-depressant. Effexor can be very helpful as can Cymbalta. It is better for you to look these up on the Internet to learn the good/bad about them.

Also, if he shows any tendency toward attention deficit, you might try Adderall. Believe it or not, the stimulant actually will help him be more calm and attentive. What happens in ADD is that the mind cannot process the onslaught of incoming information and the overload comes out as agitation or violent behavior. By speeding up his mind, he will be less overwhelmed.

Don't let them tell you he cannot have both ADD and HFA, because he can. They are not mutually exclusive.

For our daughter, a combination of an ADHD medication and an antidepressant has been the most successful regimen.

Also, you need to acquaint his teachers with the idea of behavioral triggers. Most HFA kids act out when the environmental input overwhelms them. Florescent lights (which make noises and flicker in ways that autistic children find intolerable), high-pitched noises, sudden changes in routine and many other things can set them off. They need to give him lots of time to transition from one activity to another. Even something as simple as a hat or earplugs to soften the input may be very helpful for him.

Use some of the links I put at the end of this message to find more information.

Best wishes,
Catherine