Expert: Catherine Ridenour - 11/2/2006

Question
I have a nephew who is 2.5.  He has does not speak.  He used to be uncontrollable, often banging his head, crying, not listening, etc.  The doctor prescribed Risperdol.  He is now much better, able to focus.  We went for a second opinion, and the second doctor says probably not autistic, but hyperactive.  From what I've read, if he is truly hyperactive then he shouldn't be on risperdol, but something in the ritalin family?  The doctor that said he was autistic said if he were on ritalin he would go crazy.  Who is correct here?  If the risperdol is helping, which  it is tremendously, does that mean he is autistic and not hyperactive?  I'm confused.

Answer
Hi Margie,

No wonder you are confused. I would be, too.

Risperdol is not, techincally, a medicine for autism in the same way that Ritalin is for ADHD. It was invented to deal with psychosis but can be helpful for some autistic children. Beware, it can cause severe weight gain.

MANY children with autism are mis-diagnosed as hyperactive, bi-polar, retarded or just plain "crazy." This is because autism presents with similar symptoms and not all the same ones in each individual.

Head banging is common in autistic children, not ADHD.

Ritalin will not make him "crazy" if he's autistic, but it won't do him any favors if he does not have ADHD. A child can be both and sorting it out can be difficult.

My daughter takes Adderall, an ADHD medication, as she has both Asperger's syndrome (an autistic spectrum disorder) and attention deficit disorder. It helps a lot. We are of the opinion, if it helps, dang the diagnosis and use it.


You need to be aware that most of the ADHD meds are stimulants which would make you think it would increase hyperactive behavior. But, the reason that hyperactive children run wildly about is that their perception system is too slow to cope with the stimuli around them. The stimulant medications speed up the brain so that it can process information at a normal pace. Then, the child can pay attention.

I fear you need a third opinion. This time, try to find a child psychiatrist who is familiar with autistic spectrum disorders and willing to do some testing before he whips out the prescription pad.

Here is a list of web sites where you can learn more.

http://www.patientcenters.com/autism/news/resources.html (books and resources)

http://www.ninds.nih.gov/disorders/asperger/asperger.htm (the definitions and government links)

http://www.autism.org/temple/meds.html (about medication)

http://www.autism.org/ (many links to information)

http://www.autismasperger.net/intro.htm (Stephen Shore’s web site)

http://www.angelfire.com/pa5/as/asteachersites.html (teaching resources)

http://www.aspergers.com/Adolesc.htm (adolescence issues)

http://www.mentalhealth.com/ (a site where you can enter symptoms and get a possible diagnosis)

http://www.pnas.org/cgi/content/full/95/23/13982#B14 (About movement in infancy)

http://groups.msn.com/TheAutismHomePage/toilettraining.msnw (toilet training)

Best wishes,
Catherine