Is medication a good autism strategy?

More often than not, the parent of a child on the autism spectrum, or of one who’s been diagnosed with a learning disability, has faced the question of whether medication is a good autism strategy. The same question holds true with professionals–‘Is medication a good autism therapeutic intervention tool?’.

With numerous drugs, dosages and medical opinions on the matter, what is the right choice?

“Don’t overmedicate,” cautions Dr. Greenspan. “If you get a beneficial effect, hold it there. Don’t try to get it ‘perfect.’”

As Dr. Greenspan notes, medication is like a sledgehammer: it is not a perfect science; you can’t make completely accurate dosage determinations. If the child gets too much medication, it will often subdue other developmental functions that you don’t want to subdue.

“When you ask the medication to do less,” he says, “it’s more likely to work.”

Most importantly, Dr. Greenspan emphasizes that children should have an optimal program before medication is introduced. With the support of a good therapeutic program in place first, your child will need less medication. There will be less probability of overmedication, and you aren’t asking the medication to do the whole job.

Listen to Dr. Stanley Greenspan answer this question in his own words below:

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Which autism intervention strategies are best for your child? Here are three things to avoid.

Discussion: To help your child relate, communicate, and think, it’s important to create the best intervention program available. There are a number of strategies that your child may respond positively to, but there are also interventions that you should avoid.

“Steer clear of overly structured exercises, like behavioral approaches,” Dr. Greenspan proposes. “That’s not a natural way of learning, especially with a little baby,” he counsels. “It could really undermine a baby’s nervous system.” Approaches that are natural, healthy and appropriate for a neurotypical child are called for, especially with very young children. “You can do more of what’s natural and healthy and do it in an innovative way,” says Dr. Greenspan.

Something else to avoid? Daycare. Group daycare is bad for children who are at risk for autism – there are not enough caregivers per child, and the child does not get the sustained engagement that is necessary for healthy development.

The other advice Dr. Greenspan dispenses is common sense: “Do not expose the baby to toxic chemicals; pay attention to cleaners, paints, and mold. Don’t unnecessarily expose the baby to any toxins of any kind.”

From the early intervention point of view, avoid overly structured exercises like that recommended by behavioral approaches because that’s not national natural way of learning. I really worry about preventive intervention work for children from strategies like the conditioning strategies, the drill oriented things to get the baby to look or to get the baby to repeat certain sounds. That could really undermine a young baby’s nervous system. That worries me be very very deeply, and I’d rather see preventive work not done because that’s not natural.

You know I don’t recommend it for older children with special needs but there I know often it may not result in good progress but without any negative effects. But for babies, it could create serious negative effects. So the principle is only do approaches that are natural that would help a normal healthy child. Don’t create unnatural ways of learning. You can do more of what’s natural and healthy and do it in a more Innovative way to transform that natural ability.

Group group daycare is a no-no for children at risk because in the group daycare environment, you have four babies for one caregiver. You can’t do the kind of sustained engagement, sustained back and forth interactions you’d like to do. It’s just like a mom with quadruplets. It’s going to be impossible even with the most gifted caregivers in the best daycare centers.

It’s just simply a ticket to increase the risk. So getting help at home, maybe from a neighborhood person who’s only taking care of one or two children and really will be devoted to the baby if a mother needs to work. You need a very low ratio situation, a one on two situation. You can look for a working situation from either yourself, relatives, grandparents, a neighbor, someone who’s going to help and not going to let the child for hours be on their own making matters worse.

Another no-no is exposing the baby to toxic chemicals. You don’t do floors that give off odors, which have petrochemical solvents in the room. You don’t expose the baby to things that they can ingest.

Dr. Stanley Greenspan

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How should a parent integrate different autism treatment strategies? How can a parent know whether an autism treatment strategy is right for their own child?

Discussion: In addition to the Floortime therapy, you may want to consider new and innovative interventions that are coming to the fore, suggests Dr. Greenspan. “No one intervention, no matter what the data, was tried out on your child. So, you’ll always have to come up with creative and innovative strategies.”

If something has been helpful to a lot of children, it may be helpful for your child; but, you always want to watch and observe. Never assume a strategy will be successful. Dr. Greenspan notes that “it’s critical to recognize that you’re always observing the effect of an intervention on a child” and that this is “especially important for medication and nutritional remedies.”

Learn more about autism treatment strategies through Floortime U. courses!

The profile allows you to assess other innovative interventions too that are coming in or that are being tried. Again, no one intervention, no matter what the data on it is, it wasn’t tried out on your child. So you’ll always have to come up with creative and innovative strategies.

You have an n [sample size] of one. Obviously, if something has been helpful to a lot of children and has a lot of studies behind it, you have more reason to believe it may be helpful in this situation. But you have to watch and observe. Will it be helpful and not undermine the child’s functioning?

Sometimes there are things you want to try that have been tried but there aren’t enough studies yet. But you you feel that it’s safe and you want to give it a try anyhow. This gives you a way of observing whether it is going to be helpful. So it’s critical to recognize that you’re always observing the effect on a particular child regardless of the amount of studies being done because every child is unique and different.

I find it especially important with medications and a lot of nutritional remedies as well. Often they can be helpful but often they can have negative effects as well. We have to observe it in the child to find what’s going to work for that particular child.

Dr. Stanley Greenspan

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Discussion: “What if you’re in a situation where you need to set a limit?” asks Dr. Greenspan. With Floortime, it’s very important for limit setting to take place under the umbrella of calm, back and forth interaction.

“The child with autism should learn in a negotiated way,” reminds Dr. Greenspan. The ideal way to set limits using Floortime is in a situation where you have time and you can interact with the child around the limit. You can give the child an alternative, or negotiate, and it’s done calmly together.

But, notes Dr. Greenspan, there are situations where you have to operate quickly, like if the child with autism is about to run into the street or hurt himself. “There, you’re going to awaken catastrophic affects, but then you’re going to try to soothe the child and bring him back into co-modulated interaction and talk about it quickly,” advises Dr. Greenspan. Do it in as nice a way as possible, soothe, and if it’s an autistic child who is verbal, talk about it. If it’s not a verbal child, get the child back into regulated Floortime interaction. Then, try to practice that situation in an interactive way so you’re not caught in that catastrophic mode again.

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How can a therapist identify short-term goals when implementing the Greenspan Floortime approach?

Discussion: It can often seem difficult to quantify Floortime progress, but it doesn’t have to be.

The question we seem to be asking ourselves is: “how do we use the DIR model in terms of getting funding when the funding agency wants you to earmark ‘short term goals’?” notes Dr. Greenspan.

One way of thinking about this is to look at developmental capacities and target these as your symptoms: the absence of the capacities, of gestures, of engagement, of warmth, and so forth.

“Then,” says Dr. Greenspan, “when the child reaches these milestones, it indicates mastery of those symptoms. This way, you can show nice, short term gains often. In one session, you can see clear changes.”

[Researchers and therapist practitioners] sometimes ask how to use this [Floortime] model in terms of getting funding when the funding agency wants you to earmark short-term goals and many HMOs want short-term goals. And it’s important for many research projects.

Obviously we’re talking here about a long-term effect. One way of thinking about the short-term goals is to look at these developmental capacities that we’re talking about like engagement, two-way gestural communication, using ideas. Target these as your symptoms–the absence of these capacities, the absence of gestures, the absence of using ideas, the absence of engagement with warm smiles.

Then obviously the presence of warm smiles, the presence of pointing and gesturing, the presence of problem solving like taking you by the hand walking to the door, the presence of using words in pretend play, or in “Me Want Cookie,” they become the remediation of these symptoms. The mastery of those symptoms of the absence of these needed abilities

Dr. Stanley Greenspan

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Discussion: How do you identify what approaches work best for a particular child? If you are a clinician, how do you help parents figure out what approach is best for their child?

“These are questions that can be answered during the assessment process,” says Dr. Greenspan. “In the assessment, have parents play with their children. That way, you’re demonstrating with the parents, through coaching, what can happen as they engage or gesture more. The parent is your colleague in this process – they are witnessing whether this works for the child.”

You can ask the parents to demonstrate the approaches they’ve been using to reach a goal, such as learning colors, and then ask them if they’d like to try a more dynamic way. “If the task is hooked to the affect it generalizes more quickly. The parents’ overall goal is to try to get their child to develop better – we all want that,” imparts Dr. Greenspan.

Sometimes the parents may be focused too much on a particular behavior, e.g. learning colors, rather than the more important skill of thinking, (having the child think about why they like red more than blue). “We tailor the program to the child’s nervous system, not the other way around. We want what works, and what will help the child climb the developmental ladder,” explains Dr. Greenspan.

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Discussion: School does not mean education. What should an ideal educational program have?

You have to look at the school environment in terms of how well it can provide support for the six functional milestones, and then the higher milestones beyond that. How well can an educational setting provide remediation for the different processing areas? To what degree does the educational setting provide one-on-one or small group settings that are going to promote development?

We recommend a thinking-based curriculum and a thinking-based approach to literacy. For instance, when working on causal thinking, you need to work on that level in all the different subject areas.

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Discussion: One of the real challenges with children with special needs is grappling with how you help them master reflective, analytic thinking – seeing the big picture and making inferences.

In studies comparing children with autism to children without autism, who are matched for IQ, the separating factor isn’t academics.

“What separates special needs populations from non-special needs populations is the ability to think at a highly reflective level,” points our Dr. Greenspan.

He continues: “What separates them is the ability to engage in reciprocal interchanges and back and forth communication, as well as the pragmatic use of language, and the capacity for theory of mind tasks and empathy.”

If we look only at educational achievements when assessing how successful an intervention strategy is, we will be misled; it will look as if the child is making strides, but in reality, “they can’t cope with the real world,” Dr. Greenspan observes.

The special needs population will have more difficulty making friends, creating new ideas and making inferences. Academic gains are important, but we want to encourage the development of higher level thinking skills. All children with special needs need a language curriculum that can help them with higher level thinking skills. “We need to be able to offer the appropriate programs,” notes Dr. Greenspan.

For instance, all children with special needs need a language curriculum that encourages meaningful and purposeful communication. “We can do a lot better by these children,” he adds.

To learn more about Dr. Greenspan’s intervention strategies and methods for encouraging higher level thinking skills, consider registering for our parent or professional course.

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Discussion: “For most of the kids who are older and on the autism spectrum, the big problem is service and educational communities giving up on them,” states Dr. Greenspan, and abandoning thinking skills in the process. We shouldn’t stop challenging older children simply because they are autistic.

That isn’t to say that life skills aren’t valuable, notes Dr. Greenspan. “You can do that as part of opening and closing circles of communication and teaching thinking skills. When you use life skills training as an excuse to stop the thinking process, then you create a leveling-off of learning.”

It shouldn’t be thinking skills versus life skills; it’s the way you consider the entire program and how you inspire imagination within the older child or teenager. It can be difficult if the older child is still under the influence of catastrophic affects, but we want to continue to improve the quality of the person’s life.

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Discussion: As a clinician or therapist doing the family assessment, you will be able to sense if there will be a deeper resistance from the parents, states Dr. Greenspan. “They will speak about what they do and don’t do, and the ways they are comfortable or uncomfortable interacting.”

After that happens, suggest that they try something different at home, and encourage them to explore interactions beyond their comfort level. In the next session, ask them how it feels. “Be supportive and gentle, and do it in the context of the family, remembering that each family is different,” urges Dr. Greenspan.

You can ask parents or family members to try different activities during the assessment, and gauge the levels of discomfort. If there is resistance, take a break from the activity and talk about it. Above all, reminds Dr. Greenspan, “Be very empathetic about what feelings the parents or family members express.”

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