Do any of you medicate for violence?

Mike

Keep to your word. Once you have agreed to something with your child it is important to try to keep to it. Extreme anxiety can occur when something they expect to happen does not.

Try preventative measures. For example think of things to distract the child from whatever may be upsetting them.

Encourage your child to go out in to the garden or somewhere safe when they are becoming angry or upset. Make sure that they can get there easily without encountering too many obstacles on the way.

Channel behaviour positively. If your child goes in to the kitchen and smashes the crockery when they are anxious, think of ways to channel this. For example keep cheap crockery from car boot sales in a marked box and set some rules such as 'you can smash this crockery at the bottom of the garden' or may be a visit to the bottle bank could provide a similar output for this energy.

Listen to your child. More able children with autism may be able to express in some way to you what is upsetting them. This may occur at the time or in many cases hours or even days later. Observe your child's behaviour and see if you can notice any patterns. What are they trying to tell you?

Consider the iceberg effect. You may see a particular behaviour, but the underlying reason may not be clear. When a child starts behaving differently assess if there have been any changes in the child's routine or environment at all. Also consider whether there may be a medical reason underlying their distress. Head banging for example can sometimes occur when a child has an ear infection and similarly biting can sometimes be due to toothache.

Choose the right incentives. Think of things to motivate your child to behave. What things do they enjoy? What will they find rewarding? For some children using whatever their obsessional interest is can be particularly rewarding. So for example if your child really enjoys watching Thomas the Tank Engine videos allow him or her to watch this after they have done something good or behaved well.

Be consistent. Whatever strategy you choose to use with your child it is essential that you are consistent. To be successful, all those involved with your child should use the same strategy and language in response to your child's behaviour. It is very important that children with autism have clear boundaries.

Useful reading

Clements, J. and Zarkowska, E. (2000). Behavioural concerns and autistic spectrum disorders: explanations and strategies for change. Jessica Kingsley Publishers: London*

Clements, J. (2005). People with autism behaving badly: helping people with autism move on from behavioural and emotional challenges. Jessica Kingsley Publishers: London *

May, F. (2005). Understanding behaviour. NAS: London*

(This is also available as free information sheet from the Autism Helpline.)

Schopler, E. (1995). The parent survival manual. Plenum Press: London

Whitaker, P. (2001). Challenging behaviour and autism: making sense - making progress. NAS: London

See the behaviour section on the NAS website: www.autism.org.uk/nas/jsp/polopoly.jsp?d=1070

Disciplining the child with autism

Children with autism need guidance on appropriate behaviour.

Does your child understand what they have done wrong? Make sure they know what they have done wrong and why. So for example instead of saying 'You have been naughty today' say 'You took your sister's sweets, they are not yours'.

Focus on behaviour not the child. Tell your child if you are unhappy with what they have done, not what they are. So for example don't say 'You are naughty' but make it clear that what they did was wrong.

Be aware that your child with autism may not learn from experience. They often have great difficulty applying what they have learnt in one situation to another. Your child may require very clear and consistent instructions.

Reinforce good behaviour. Try to reward good behaviour and where possible ignore the bad behaviour. Any attention, even being told off can be rewarding for a child.

Some people claim that it can also be used to treat some of the core symptoms of autism, such as poor social communication or repetitive behaviours.

Risperidone may be beneficial for the treatment of various problems faced by people with autism, including irritability, repetition and hyperactivity.

However there are many potential side effects, especially weight gain, drowsiness & raised serum prolactin levels.

There is anecdotal evidence that a number of other atypical antipsychotics, such as Quetiapine & Olanzapine, are beneficial in treating anxiety / aggression, but at present no firm evidence base.

Ortho-McNeil-Janssen Pharmaceuticals is the manufacturer and here are a couple of informative sites:

http://www.risperdalautism.com/risperdalautism/

http://www.janssen.com/janssen/therapy-areas.html

And here is the "package insert": http://www.rxlist.com/cgi/generic/risperid.htm

http://www.rxlist.com/script/main/hp.asp

that is the same link I used to look up the medication.

Our thought is that the worst of two evils is the side effects of the medication so we use the strategy that Shell spoke about above and we re-direct/guide........until he is through.

Granted, I am sitting here, at my desk, in severe back pain because our son had a "meltdown" yesterday that went out of control and we had to restrain him, to keep his brother's safe (that and my husband had to take the other kids with him, in the other car - we were an hour away from home and this son has bonded with me so he responds to me better than to my husband or anyone else).

shell

And, keep in mind, that medication does not have to be a permanent solution, although if your son is having some severe problems it may be long-term for you. My son has always had difficulty with transitions from one thing to another and would frequently respond aggressively. Anecdotal evidence suggests that there may be an anxiety component to this behavior, and his neurologist suggested a small dose of Zoloft (an anti-depressant/anti-anxiety drug). His ability to transition did improve dramatically, but his hyperactivity got a little bit worse. Basically, he had trouble sitting still and constantly craved sensory input. After about two years on the drug his doctor suggested taking him off to see how he would do. He continued to transition well, and the hyperactive behaviors went away. He is now taking no medication for autism symptoms.

If you do decide to try medication, my advice is to make sure that you know what it is supposed to do and what to expect as far as side effects. Our doctor's philosophy is to medicate only enough to get a benefit and only as long as you have to, and I tend to agree with that philosophy. You may need to ask yourself some difficult questions, like whether or not his life (and your family's) will be better off with the medication.

I wish you the best - this is not an easy decision to make.