Managing ADHD in Children with Autism: Medication and Behavioral Strategies

Q: Managing ADHD in Children with Autism: Medication and Behavioral Strategies

Hello： Caring for a child with severe autism is a long and challenging journey, so please take care of yourself first. <br>The symptoms and behaviors of your child are not anyone's fault. <br>You have clearly described your child's condition and the efforts you have made in the p

Attention Deficit Hyperactivity Disorder (ADHD)

Dear Dr.
Liang,
My child has severe multiple disabilities and is diagnosed with autism.
Since starting junior high school (currently in the first year), his condition has become quite unstable.
He is currently taking the following medications: DEPAKINE (500 mg) one tablet in the morning and one in the evening, LAMICTAL (50 mg) one tablet in the morning and one in the evening, MOREFINE (100 mg) one tablet in the morning and one in the evening, B.H.L.
(2 mg) one tablet in the morning and one in the evening, Rivotril (2 mg) two tablets before bedtime, Dormicum (7.5 mg) two tablets before bedtime, and MOREFINE (100 mg) three tablets before bedtime.
It truly pains me to see my child on so many medications, and I feel helpless!
At the beginning of the school year, his behavior was very unstable; he would frequently run out of the classroom, scream, and hit his ears when angry.
Despite the teachers' efforts to use redirection and behavioral therapy, there was little improvement.
It was only after starting MOREFINE that his condition began to stabilize.
However, after five months on this medication, the teacher reported in January that his stability has not been as good as before; he often leaves his seat during class, screams, and hits his ears, disrupting the class.
The teacher has to spend a lot of time and energy on him.
At home, we try various methods, including educational materials, exercise equipment, and outdoor activities, to prevent boredom and behavioral issues.
However, his responses are either short-lived or completely non-compliant, making it very challenging to implement these strategies.
I constantly worry about my child and his issues.

He has always had hyperactivity problems, but previously we could manage it through other means, and he was more compliant.
However, as he has entered puberty, his compliance has decreased, and his strength has increased, making it harder to manage him.
The hyperactivity has also led to pressure from teachers, arguments between my spouse and me, and a tense family atmosphere.
The external injuries and punishments related to his hyperactivity often leave me heartbroken and in tears.
I would like to ask the doctor if there are any medications that can improve or alleviate hyperactivity associated with autism and epilepsy.
About six months ago, he was on Strattera, but we had to discontinue it after the second week due to manic symptoms.
We also tried Ritalin for two weeks, but the teacher noted negative effects on the third day, with increased behavioral problems and restlessness, so we stopped that as well.
I hope for your assistance and guidance.
Thank you!

Xiao Tian Shi Mu Qin, 40~49 year old female. Ask Date: 2011/03/08

Dr. Liang Sunyuan reply Psychiatry

Hello: Caring for a child with severe autism is a long and challenging journey, so please take care of yourself first.
The symptoms and behaviors of your child are not anyone's fault.
You have clearly described your child's condition and the efforts you have made in the past, which shows that you are dedicated to their care.
Helping such a child cannot be done alone; it is advisable for family members to understand and support each other in facing these challenges together.
The emotions of parents and children often influence each other; the child's problematic behaviors can create stress for parents, and parental stress can affect how they interact with and perceive their child.
Sometimes, when the child's issues cannot be improved immediately, an improvement in parental emotions can lead to more stability in the child's condition.
It is also important to maintain a cooperative relationship with school teachers and work together to find ways to reduce the child's problematic behaviors.
Regarding medication, certain medications may help reduce self-injurious behaviors, hyperactivity, agitation, and repetitive behaviors in children with autism.
If the current medication is no longer effective for your child, it is recommended that you discuss with your outpatient physician whether a change in medication is necessary.
Your clear description of your child will be helpful for the physician to discuss future treatment plans with you.
Wishing your child stability soon.
Sincerely, Liang Sun-Yuan, Changhua Hospital.

Reply Date: 2011/03/08

More Info

Managing ADHD in children with autism, especially those with additional challenges such as epilepsy, requires a multifaceted approach that combines medication, behavioral strategies, and supportive interventions. Your situation highlights the complexities involved in treating a child with multiple disabilities, and it's understandable that you feel overwhelmed by the challenges your child faces.

Understanding the Medications
The medications your child is currently on, including Depakine (Valproate), Lamictal (Lamotrigine), and Morefine (Methylphenidate), are often used to manage symptoms associated with epilepsy and ADHD. While these medications can be effective, they can also have side effects and may not always provide the desired level of control over symptoms. It's crucial to work closely with your healthcare provider to monitor the effectiveness of these medications and make adjustments as necessary.

1. Depakine is primarily used for seizure control but can also help with mood stabilization. However, it may not directly address ADHD symptoms.

2. Lamictal is often used as a mood stabilizer and can help with mood swings, which may be beneficial if your child experiences emotional dysregulation.

3. Morefine (Methylphenidate) is a stimulant medication commonly prescribed for ADHD. While it can improve focus and reduce impulsivity, it may also lead to increased anxiety or agitation in some children, as you've experienced.

Behavioral Strategies
In addition to medication, behavioral strategies are essential for managing ADHD symptoms in children with autism. Here are some approaches that may help:
1. Structured Environment: Establishing a consistent daily routine can provide a sense of security and predictability for your child. Visual schedules can be particularly helpful for children with autism, as they can see what to expect throughout the day.

2. Positive Reinforcement: Use positive reinforcement to encourage desired behaviors. This can include praise, rewards, or privileges for following rules or completing tasks. Reinforcement should be immediate and specific to be most effective.

3. Social Skills Training: Engaging your child in social skills training can help improve their interaction with peers and adults. This can be done through structured programs or through play-based learning.

4. Sensory Integration Techniques: Many children with autism have sensory processing issues. Identifying sensory triggers and providing appropriate sensory breaks or tools (like fidget toys or weighted blankets) can help manage anxiety and improve focus.

5. Behavioral Therapy: Consider working with a behavioral therapist who specializes in autism and ADHD. They can provide tailored strategies to address specific behavioral challenges and help your child develop coping mechanisms.

Collaboration with Educators
It's crucial to maintain open communication with your child's teachers and school staff. Collaborating with them can help ensure that your child receives the support they need in the classroom. Here are some strategies for effective collaboration:
1. Regular Meetings: Schedule regular meetings with your child's teachers to discuss progress, challenges, and any necessary adjustments to their educational plan.

2. Behavioral Plans: Work with the school to develop an Individualized Education Program (IEP) or a 504 Plan that outlines specific accommodations and interventions tailored to your child's needs.

3. Training for Staff: Advocate for training for teachers and staff on autism and ADHD to ensure they understand your child's unique challenges and how to support them effectively.

Emotional Support for Parents
Caring for a child with multiple disabilities can be emotionally taxing. It's essential to take care of your own mental health and seek support when needed. Consider joining support groups for parents of children with autism and ADHD, where you can share experiences and strategies with others facing similar challenges.

Conclusion
Managing ADHD in children with autism, particularly those with additional challenges like epilepsy, requires a comprehensive approach that includes medication, behavioral strategies, and collaboration with educators. It's essential to remain patient and persistent, as finding the right combination of treatments and strategies can take time. Regular communication with healthcare providers, educators, and support networks will be vital in navigating this journey. Remember, you are not alone in this, and there are resources and communities available to support you and your child.

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