11/11/2018 T he ABCs of Me dic ation Manage me nt for Autism - PDF document

11/11/2018 T he ABCs of Me dic ation Manage me nt for Autism Spe c tr um Disor de r OR HO W T O C O MPL EMENT BEHAVIO RAL T HERAPY ABC L ogging (F BA) F ir st  We ne e d to kno w wha t, whe n, whe re a nd why b e ha vio rs ha ppe n.  Ante c e de nt : Wha t ha ppe ne d rig ht b e fo re the b e ha vio r?  Be havior : i.e . ra g e , se lf injury, a g g re ssio n, e lo pe me nt, ste mming , withdra wa l  Conse que nc e : Wha t ha ppe ne d rig ht a fte r the b e ha vio r?  Possible F unc tion: g e tting a tte ntio n, a c c e ssing ite m o r a c tivity, e sc a pe , se nso ry (Wha t wa s the o utc o me fo r the c hild? )  Ke y Point: T he r ape utic inte r ve ntions to c hange be havior s should be e xplor e d BE F OR E me dic ation manage me nt is c onside r e d. ABC L ogging  We ne e d to fig uring o ut why a c hild a c ts a c e rta in wa y a nd unde rsta nd wha t’ s b e hind the ina ppro pria te b e ha vio rs.  K no wing wha t’ s b e hind the b e ha vio r c a n he lp find wa ys to c ha ng e the b e ha vio r. A c hild’ s b e ha vio r se rve s a purpo se a nd e xpre sse s a n e mo tio n.  We ne e d to fig ure o ut wha t trig g e rs c e rta in b e ha vio rs in yo ur c hild. It’ s impo rta nt to re me mb e r tha t the c a use s fo r the sa me b e ha vio r is diffe re nt fo r e ve ry c hild.  Ke y Point: WHY a c hild re ac ts the way the y do not only he lps with be havioral the rapy planning but c an guide me dic ation tre atme nt options. 1

11/11/2018 ABC L ogging  De fine the be havior :  Give a g o o d de sc riptio n o f c hild’ s b e ha vio r.  I t’ s impo rta nt to de sc rib e the b e ha vio r in a n o b je c tive , spe c ific wa y. T his c a n he lp to fo rmula te a b e ha vio ra l inte rve ntio n a s we ll a s he lping to c a te g o rize the b e ha vio rs a nd e mo tio ns. Do e s the b e ha vio r re fle c t a nxie ty, de fia nc e , sa dne ss, distre ss?  Ke y Point: Physic ians don’t ofte n obse rve a c hild's e motional or be havior al dysr e gulation in our offic e . Impor tant De tails on Be haior s  Colle c ting, c ompar ing and analyzing infor mation:  Whe re is this b e ha vio r ha ppe ning ?  Whe re is it no t ha ppe ning ?  Ho w o fte n is the b e ha vio r o c c urring ?  Who is a ro und whe n it o c c urs?  Wha t te nds to ha ppe n rig ht b e fo re a nd rig ht a fte r the b e ha vio r? What is My Child’s Be havior T e lling Me ? 2

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11/11/2018 Have T he r apy in Plac e  De ve loping a plan:  Onc e we kno w the c a use fo r a c hild’ s b e ha vio r, c a n c ha ng ing so me thing in the e nviro nme nt c ha ng e the b e ha vio r?  Ca n the physic a l e nviro nme nt b e mo difie d?  Ca n a c ha ng e b e ma de in a c hild’ s ro utine o r e ve nts tha t ha ppe n b e fo re the ina ppro pria te b e ha vio r to dive rt it?  Ca n c ha ng e s b e ma de in the re spo nse to the b e ha vio r o r to the c o nse q ue nc e s fo r a b e ha vio r?  Ke y point: Me dic ation manage me nt c an c omplime nt the r apy and should not be c onside r e d fir st nor should it be c onside r e d without c onc ur r e nt the r apy. Conside r Othe r T r e atme nts F ir st  Ma ny c hildre n with ASD ha ve c ha lle ng ing b e ha vio rs o r diffic ultie s with the ir fe e ling s a nd e mo tio ns. Ma ny tre a tme nts he lp. Me dic ine is o nly o ne o f tho se tre a tme nt o ptio ns, a nd me dic ine is no t right fo r e ve ry c hild.  I t is b e st to c o nside r me dic ine o nly AF T E R b e ha vio ra l a nd e duc a tio na l me tho ds ha ve b e e n trie d first.  Ke y point: F BA is a valuable tool that should be done . T he same infor mation gathe r e d fr om an F BA c an he lp whe n c onside r ing the ne e d for me dic ation manage me nt. T r e atme nt ‘E quation’  E motion  Be havior T r igge r  T he trig g e r c a use s a n e mo tio n.  T he e mo tio n c a use s a b e ha vio r.  T he b e ha vio r is the RE SUL T .  Only tre a ting the b e ha vio r is like putting a b a nda id o n a n infe c tio n. T ha t’ s slo ppy.  We ne e d to unde rsta nd b o th the trig g e r (using ABC c he c klist, F BA) a nd the e mo tio n b e fo re we c a n fully c ha ng e the b e ha vio r.  Ke y Point: IF me dic ation tr e atme nt is c onside r e d, we ne e d to ide ntify and tr e at a c hild’s e motional r e sponse (fe ar , ange r , fr ustr ation, sadne ss, distr e ss) and not just aim to me dic ate away the ir be havior (outbur sts, me ltdowns, aggr e ssion, se lf injury.) 4

11/11/2018 If a De c ision is Made to Use Me dic ation  It is important familie s have the right information.  A physic ia n sho uld:  E xpla in me dic ine c ho ic e s to fa milie s.  T e a c h fa milie s a b o ut wa tc hing fo r e ffe c tive ne ss.  T e a c h fa milie s a b o ut c he c king fo r side e ffe c ts a nd g o o d re spo nse .  Give info rma tio n a b o ut ma na g ing c o mmo n side e ffe c ts.  Be c le a r with fa milie s a b o ut g o a ls o f tre a tme nt, po ssib le risks a nd b e ne fits. Whe r e to F ind He lp  Me dic ine s c o mmo nly pre sc rib e d fo r ASD a re usua lly pre sc rib e d b y a pe dia tric ia n, a psyc hia trist o r a ne uro lo g ist.  Who kno ws yo u a nd yo ur c hild?  Ha s e xpe rie nc e wo rking with c hildre n with ASD a nd b e ha vio r diffic ultie s.  I s kno wle dg e a b le a b o ut the use o f me dic ine s in c hildre n with ASD.  K no ws the po ssib le risks a nd po ssib le b e ne fits o f e a c h me dic ine . T r e atme nt Que stions  T he ‘NE E D T O KNOW’ list:  Wha t e xa c tly a re we tre a ting ?  T he pro s a nd c o ns o f me dic a tio n o ptio ns.  Po ssib le side e ffe c ts a nd b e ne fits o f a ny me dic ine s fo r yo ur c hild.  Ho w lo ng will it ta ke to wo rk?  I f impro ve me nt is no t se e n, the n wha t do we do ?  I f side e ffe c ts ha ppe n, wha t do we do imme dia te ly a nd the n wha t?  Ke y point: Me dic ation manage me nt DO ES NO T A SD . Me dic ations c an T REA T he lp ame lior ate BE HAVIOR S that ar e disr uptive or injur ious, or that ne gative ly impac t home and the e duc ational pr ogr e ss. 5

11/11/2018 Ide ntify the T ar ge t Symptoms  What ar e T ar ge t Symptoms?  T a rg e t sympto ms a re tho se pro b le ms o r b e ha vio rs tha t a re c a using tro ub le fo r a c hild. It is impo rta nt to b e c le a r a b o ut wha t sympto ms a re the b ig g e st pro b le ms. T his will he lp to c ho o se the b e st me dic ine . Ha ving c le a rly ta rg e te d sympto ms will a lso he lp to me a sure if me dic ine is he lping a nd a sse ss e ffic a c y o f tre a tme nt.  Ke y point: T he re are no me dic ine s that tre at the c ore soc ial and c ommunic ation symptoms of ASD. Me dic ine s do not he lp with thinking and le arning proble ms. Howe ve r, by targe ting symptoms with me dic ine , a c hild might do be tte r in sc hool or in the rapy, whic h c an he lp the m to le ar n be tte r and impr ove and e xpe dite the rapy outc ome s. Common T ar ge t Symptoms  Hype ra c tivity  Sho rt a tte ntio n spa n  I mpulsive b e ha vio rs  I rrita b ility  Ag ita tio n  Ag g re ssio n  Se lf-injury Common T ar ge t Symptoms  T a ntrums  Re pe a ting tho ug hts, inte re sts a nd b e ha vio rs  Sle e p pro b le ms  Anxie ty  De pre ssio n  Mo o d pro b le ms  T ic s 6