• Stimulants may affect sleep and growth in developing children and, in some cases, may worsen autistic symptoms, especially self-stimulation behaviors.

  • Secretin-treated children did not differ from placebo-treated children.

  • Functional behavioral assessment to determine the function(s) of the problem behaviors increases the likelihood of choosing the correct medication and behavioral interventions.

Research is under way to predict responders and nonresponders to medication and to determine which children will benefit from behavioral treatment alone and what combinations of medication and behavioral treatment are most effective. Many parents also treat their children with nonprescription drugs and nutritional supplements. These agents have received even less study than prescription drugs, and their assessment is beyond the scope of this report. Several psychotropic medications have appeared to result in improvements for some patients but make others worse. Since medication is often instituted in a crisis, the possibility that it is actively contributing to deterioration is often not considered. Children’s responses to medication must be monitored very carefully.

Children with autistic spectrum disorders are also at increased risk for certain medical conditions, notably seizure disorders. From one-fourth to one-third of people with autism are expected to develop seizure disorders sometime in their lifetime (Bristol et al., 1996; Kanner, 2000; Tuchman, 2000). School personnel need training in recognizing the symptoms of seizures and other medical problems and in monitoring the effects of medications over time. Although technically outside the scope of the educational program, it is important that educators and parents be informed of the importance of quality medical care and both the potential value and the possible problems of pharmacological intervention.

Except in unusual medical circumstances, medications are usually not considered first-line interventions for behavior problems in young children, but an exception, for example, would be behavioral manifestations of seizure disorder. Because young children are developing and learning, it is essential that both positive outcomes and unintended side effects of medications for behavioral problems are considered and that cognitive as well as behavioral effects are monitored if a decision is made to use medication. In addition to a functional behavioral analysis of the problem behavior, medication for behavioral intervention should be based on knowledge of medical pathology, psychosocial and environmental conditions, health status, current medications, history, previous intervention, and parental concerns and desires (New York State Department of Health, 1999).

A new generation of rational drug design will be based on emerging



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