Q Our 12 year-old son is autistic. Lately his behavioral problems have been getting more severe. Medicaid covers him because of his disability and we also have private insurance. These insurances cover his medical care, but his primary care physician is uncomfortable dealing with "behavioral" issues and wants him seen by a psychiatrist. The behavioral health agency under his Medicaid plan says his behavioral problems are because of his "medical condition" so they refuse to treat him. Our private insurance has limited mental health benefits.
What type of treatments and medications are available? How can I get the proper help for my son?
A Autism, a developmental disability resulting from an unknown abnormality of the brain, interferes with reasoning, social interaction and communication skills. It is not a mental illness. The most common behavioral problems associated with autism are aggression, obsessive-compulsive behavior, anxiety and hyperactivity. Most of the parents and caregivers of my patients with autism and other pervasive developmental disorders say their main day-to-day concern is behavioral problems.
There is no single treatment that works for behavioral problems associated with autism. Each treatment program must be individualized. The most common approaches are behavioral therapy, medications, vitamins and diet, and of course family support and highly structured educational programs that include speech and occupational therapy. The educational plan should include typical academic instruction and, when appropriate, social-skill development, communication, behavior and sensory integration.
Treatment of the more severe behavioral issues should be a collaborative effort of the primary care physician, a psychiatrist or psychologist experienced with autistic individuals, teachers and therapists.
A behavioral specialist, especially one who is able to make home or school visits, may also be helpful. Case management is required in many cases to coordinate all aspects of treatment and family support.
Medications should only be used after a thorough evaluation as an adjunct to behavioral modification and structured educational programs. Commonly prescribed medications include anti-depressants, anti-psychotics, anti-anxiety medications, anti-convulsants and stimulants. Stimulants, such as methylphenidate (Ritalin[R]) and pemoline (Cylert[R], are effective less frequently, but can be useful in combination with other medications in mild cases when one of the symptoms is attention deficit.
I prefer to start with a medication with a long track record whenever possible. Imipramine (Tofranil[R], an anti-depressant, has been used in mild cases for distractibility and mild aggressive behavior Thioridazine (Mellaril[R], one of the oldest anti-psychotics, works in relatively mild cases of aggressive behavior and sleep difficulties. …