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Autism is a lifelong neurological state of being that cannot be "cured". Why do so many autistic people take medications?

So, you're here because you're wondering what medications can be used, or are often used, to manage the symptoms of autism. We have answers, but they may surprise you. 

What is autism?

Autism can be described in many ways. 

Look at the document often dubbed the "psychiatry bible", the fifth edition of the diagnostic manual of mental disorders, and it'll tell you autism spectrum disorder is a pervasive neurodevelopmental disorder. Its main characteristics are, the document says, "persistent impairment in reciprocal social communication and social interaction" and "restricted, repetitive pat­terns of behavior, interests, or activities". The symptoms are severe enough to have a significant negative impact on daily functioning, though some people with autism will require more support than others. 

Look at alternative definitions that embrace the so-called neurodiversity paradigm, and you'll get a different picture. From this perspective, autism is a genetically-based neurological variant — a rarer kind of brain wiring with high synaptic connectivity that has distinct advantages as well as disadvantages, different, but not inferior or disordered. Autistic brain wiring can sometimes (or often) make society and the sensory world around hard to navigate, but it also offers unique creativity, honesty, and out-of-the-box solutions to problems. 

No matter which approach you embrace, one thing is clear. Autism is lifelong. Autistic people are born autistic, and will be autistic until the day they die. There is no "cure" any more than there is a cure for neurotypicality, and though some autistic people can pass as neurotypical (that's non-autistic for the autism "noobs" reading this) for shorter or longer chunks of time, autism cannot be sent packing with therapy, or medicated away.

Why are autistic people often prescribed medications?

Autism itself doesn't require any medications — but yet, research shows, a whopping 64 percent of autistic children are prescribed psychiatric drugs, making them the majority. A pretty high 35 percent are even estimated to take more than one such medication, and keep in mind that this doesn't even cover medications that may be prescribed for physical medical conditions (asthma, diabetes, or whatever else), or nutritional supplements for that matter. 

In many cases, medications will be prescribed not for autism, but for legitimate cormorbidities — medical conditions a person was diagnosed with alongside their autism. The co-occurring conditions that are more common among autistic people include:

  • Mental conditions such as generalized anxiety disorder, obsessive compulsive disorder, agoraphobia, post-traumatic stress disorder, major depressive disorder, attention deficit/hyperactivity disorder, or insomnia. 
  • Physical medical conditions such as epilepsy and other seizure disorders, or gastrointesinal conditions. 

In some cases, the prescribed medications will themselves lead to such unpleasant side effects that further drugs are prescribed in a bid to manage those side effects. 

Psychiatric medications are, indeed, also prescribed with the goal of managing "autism symptoms", however — perhaps to make an autistic child easier to manage, or perhaps to help the child function better.

The main class is, in this case, antispychotics, which are used to manage angry, irritable, or aggressive behavior. Ketamine may have the potential to reduce self-inurious behaviors and restlessness, meanwhile, though it can also cause a high, hallucinations, and lead to a "Superman-like" feeling that you're invincable — which is presumably why some people use it recreationally. 

Comorbid mental and physical disorders may need to be medicated, but autism doesn't

Some of the mental disorders that are more common among autistic people, like anxiety disorders and depression, can successfully be treated with either talk therapy, medication, or a combination of both. Since these disorders are debilitating and have an immensely negative impact on a person's quality of life, they do require treatment. If they affect an autistic adult, the best treatment plan for that person is a matter of joint decision-making between them and their treating doctor. If they affect an autistic child, parents and perhaps teachers or other caregivers also have a place in making the choice. 

Physical medical conditions that require pharmacological treatment are physical medical conditions that require pharmacological treatment. There's no big dilemma there, although, as with anyone else, doctors and patients (and in the case of children, their parents or guardians) should work together to minimize side effects and ensure that prescribed drugs are suitable for the person and don't interact negatively with others that were also prescribed. 

Once again, however, autism itself doesn't require medication — and though an autistic adult, or an autistic child's family, may choose to pursue medication for aggression, irritability, or self-injurious behaviors, such behaviors are often a result of a distressing environment or a way to communicate physical discomfort. As such, it would be optimal to discover the underlying cause and see if that can be remedied, instead. 

One more word of warning — while medical doctors should take care to ensure that the medications they prescribe to their patients don't interact with each other negatively, and doctors should communicate among themselves where a person is being treated by more than one, the same safeguards aren't in place when it comes to over-the-counter or alternative treatments. These, too, can sometimes produce serious side effects or interactions. Therefore, it's safest to consult a medical doctor before taking any such medications, especially for people who are already on other meds. 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA
  • Photo courtesy of SteadyHealth

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