Medication

[Sherlock35]

Hi

(Apologies for cross posting)

I was wondering if I could get some advice on medicating hyperactive behaviour in children with autism.

Is this something that is done?

What type of behaviour needs to be displayed before paediatricians medicate?

What kind of medication is available?

I would really appreciate any help or advice or experience

Many thanks

I don't think so, is the short answer. Not purely for ASD. DD does take medication, but they are for her other dx (ADHD and mh).
If your DS is very hyperactive, has ADHD been considered?

It's been briefly mentioned but because we've changed our paediatrician, she's not keen on diagnosing him just yet. I'm finding it very very hard to keep on top of his behaviour.

I'm sure you are already doing this, but I found the ABC technique of looking at behaviour helped to unpick DD's behaviour patterns and identify some of the triggers.
A lot of the triggers were environmental and could be attributed to sensory sensitivities, so she was reacting to those. I noticed a big improvement in her ability to self regulate when we made changes to her environment.
This then highlighted the fact that the ADHD type behaviours weren't responding and were still present so this helped with the dx of ADHD, which was some time after the ASD dx.

I'm not doing that at all! I'm not sure what it is...

It really helped us, although it sounds so obvious. A is antecedent, so what happens before the behaviour, B is the behaviour itself and C is the consequence. Often the behaviour is aimed at getting a desired consequence.
So very simply DD found being in a classroom almost unbearable and would try to leave (A) she would then do something (B) with the aim of being sent out of the room (C). Preferably as quickly as possible.
So she might start off by asking to go to the toilet, but if that didn't work fake illness to go to the nurse or do something 'naughty' to get sent out. She just needed a break. But to school it was disruptive, lazy etc etc and got lots of negative feedback.
Of course, it's not as easy as that to unpick at first, but that's it in a nutshell.

An example might be that ds2 runs away when he is asked to do something that stresses him (like homework). Or he might run off due to impatience because he could not wait for something or someone, despite being asked to sit still/wait quietly. Or he might interrupt someone constantly whilst they were watching television.

Each situation might be tackled differently - talk through homework/reduce it, or factor in his impatience/avoid situations where he had to wait, OR make a plan for when someone else is watching tv, take him out of the room, give him something else to do. But none of those hyperactive behaviours would be hyperactivity, they would be a reaction on ds's part to something he found difficult - homework, waiting around, social communication/personal space/understanding someone else's needs. And thus not helped by medication, in my opinion.

Ds is not medicated, although Ed Pysc suggested inattentive ADHD two years ago. He concentrates fine and waits patiently now btw.

Or hyperactivity could be an OT issue, he might need a increased amount of sensory input - in plain man's terms, exercise, movement breaks, heavy work (like pushing a wheelbarrow that sort)

He's at an SLD school at the minute but apparently is wanting too many physical breaks. So they are working on doing calming activities with him in the afternoon.

At home his behaviour is really hard to manage. He climbs on EVERYTHING. Sofas, tables, kitchen counters, window sills, the garden wall. He throws so much stuff, books, DVDs, he overfills glasses so they spill everywhere.

He's requiring almost constant supervision at the moment and I don't know if that's just par for the course or not.

I don't have any experience of SLD schools but do you think he might be coming home a bit anxious and overwrought? Can he communicate his feelings to you (I'm not sure what age he is) Is he finding something at school overwhelming, even if they are seeking to calm him. The journey home?

Would a run around after school help? Climbing and throwing things reminds me of 4 year old behaviour; that's what they do, it is a developmental stage...is it just that he is going through this stage much later? Last suggestion..does an OT give you any suggestions about home life..I know that my son's OT has given us all sorts of ideas about how to manage him at home and get rid of the excess hyperactivity/all over the placeness..is it possible that because your son is at a SLD school they have not given you any extra help with this? I remember reading a post in Faith Mummy about how her son (with severe autism) had not been given any speech therapy because he was deemed to be already helped enough by being in special school, and how frustrating this was, also the attempts to get an OT on board.

Apologies if this all wide off the mark, but might it be worth asking for help with OT and SALT and for you to be involved, rather than it just being a school matter.

Sorry not 4 year old, but maybe 2-4 year old stage (the trajectory stage I mean) certainly I can remember all the children which visited at that age driving me insane with their climbing and pulling things out..looking back I think I should have perhaps put more things out of reach and prepared for the worst, ie: putting furniture which they could climb away (ie folding chairs) making chest of drawers safely pinned to the wall, bookshelves with no books low down etc.

If he wants (needs?) more physical breaks, it sounds like school should be building them in. What are the calming activities they are going in the afternoon? Is your DS able to tell you whether he does find them calming?
I know my DD is often agitated when she gets home and it's often just down to journey home - copped up in the taxi. School has agreed to take her for a walk just before the end of the school day. Would something similar work for your DS?

He's not able to tell me if anything is wrong or if he's anxious. He always seems fairly keen to go to school and his home school book usually says he's been co-operating with the routine.

I think the calming activities today included threading but they gave me a list of things to try at home.

It's definitely not just a school matter. His behaviour at home is often dangerous as he isn't really aware of any danger. I can ask via school to speak to an OT, I think.

Sorry, I wasn't implying it was just a problem for school, only that it sounded like school could maybe do more to meet his need for movement. That might also have a positive impact on his behaviour at home.
My DD wouldn't find a fine motor activity like threading at all calming if what she really wanted to do was move around! Do you feel that it works for your DS? If so, you could ask school for the strategies that work and maybe try similar at home.
I think asking for some OT input (via school or GP) is an excellent idea.

I wouldn't be fobbed off over the OT. He needs to have some proper OT input - if he is in an SLD school, presumably he has an EHCP - has there not been an OT assessment and details of his "needs" sensory/motor recorded in the EHCP? Ds has an OT at school, and an OT from the NHS doing parent led sessions. He can run, he can walk, he can write, he can do self care but he still needed an OT to give us strategies to help him be happy and independent. He is 14! Surely your son, at a much younger age, deserves as much as mine.

It is not the school's fault, it is just that what happens at home with you is going to be just important to his education and learning as what happens at school, so the powers that be, cannot say it is not their responsibility to support you with this aspect of his life ,namely your "life" with him at home being completely hyperactive and all over the place. The same with SALT. Teaching him to be able to express his needs, will make so much difference to his education, could be with PECs could be transitioning objects that he associates with calming down when he gets home, or ways to express how the day has gone - I'm not a SALT so I do not know, but children tend not to tell you how their day has gone, even when they can talk, they just behave in such a way that it communicates how their day has gone - too much sitting, too much concentrating, too much focusing. You know, because they start rushing around when they get home, or they are too tired to switch off and seem hyper because they cannot control their emotions (the reasoning part of the brain is too tired to control the unreasoning part, that takes effort)

Playdough is good, as is bubbles in a washing up bowl (plastic under neath on the floor or table!) A bath is a lovely leisure activity with lots of splashing, to do in the afternoon after school, rather than at bedtime. But mine needed to actually climb things, or deep pressure (think burying in cushions) or run around, nothing else would do, at that stage in their lives, I don't think you can make a wired child sit still for long without some proper physical outlet. Dancing is another good one to do at home, I've just thought, we did a lot of that.

Thanks for all your advice. I'm due to see his paediatrician in a few weeks so I might mention it to her and see what happens.

I had a PTA meeting at his school the other day and it's made me realise how much I don't know about what's happening at school. I know his class teacher has done a sensory profile but I have no idea if he's been assessed by an OT or not.

I feel like I have been a massive failure as far as parenting him goes sometimes. Like I don't know enough about him or his autism to be able to fight his corner properly.