No Magic Pill for Autism: On Risperdal and the Importance of Autism Education

by Kristina Chew, PhD on October 8th, 2006

Risperdal has won FDA approval to treat “symptoms of autism” in children, as reported on Friday, October 6th, in Reuters and in many other media outlets. Risperdal, which is manufactured by Johnson & Johnson, can now be used to treat aggression, “irritability,” and “deliberate self-injury.” FDA approval was based on two eight-week studies in which 156 autistic individuals (aged 5 - 16; 90% of those in the study were aged 5 - 12) took either the medication or a placebo.

Johnson & Johnson said Risperdal does not treat core autism symptoms such as communication problems and trouble with social interactions, but “it has been shown to be beneficial in treating the associated behavioral disturbances that can interfere with school, learning and family life.”

Risperdal, which has been sold since 1993 for short-time treatment of schizophrenia in adults, is Johnson & Johnson’s biggest selling product.

My son Charlie has taken Risperdal since the spring of 2004. We did not want to put Charlie on medication; it was something near a last resort. Charlie was not in the right school situation at that time; he was getting older, getting more aware of the world, and getting more frustrated more frequently; his self-injurious behavior (head-banging) was worsening, as was his aggression against other people. Learning had come to a sad halt. Charlie was not happy and who could be with the expectation of daily tantrums, daily humiliation in front of his schoolmates, and no one sure what to do?

The medication was to be a starting point—-the pediatric neurologist emphasized that Charlie’s education was the most important thing that would help him.

And that is what medication, and certain biomedical treatments, can do for autistic children. They can help them function better in terms of getting some kinds of very difficuly behaviors more under control. They are never the answer. The medications might help to control anxiety, impulsiveness, or aggression, but the tendencies to these are still latent in Charlie. Teaching him how to cope with his anxiety is a slow process, often with many stops and starts, but teaching a child to pause before doing something, to learn to ask for what he wants instead of grabbing or acting out, to sit down and use a pencil or do a puzzle when he is agitated, is the best medicine of all, with the most long-term results.

And with the best side-effects, while those of Risperdal, and any medications, are a challenge in themselves to deal with. Risperdal causes weight gain, constipation, and drowsiness—-it was very clear that Charlie wanted to eat more after he started taking Risperdal. He did not gain as much weight as some children have (30 or so pounds, in some cases), but Charlie did have periods when he seemed puzzled and even uncomfortable with his growing stomach. We try hard to make sure that Charlie exercises every day (bike rides, swimming, and walks). The side effects of this have been not only that he is stronger: The exercise seems to help Charlie cope with his anxieties, by giving him a physical outlet for his energies. Plus, Charlie gets a huge sense of pride and accomplishment to be biking down the street (near the sidewalk, always), beside his dad.

Ever since Charlie was diagnosed with autism, we have heard talk of a cure, as in this recent essay by Alison Singer of Autism Speaks. We do not think that Charlie needs to be “cured” from autism (as I wrote in Dangerous and Misleading: On cure, lfa, hfa, and autism). We do think that Charlie needs to be educated and to be taught, and that education helps him the most and has the best side-effects.

More and new medications and medical treatments might be developed as a result of the research Singer refers to, but it seems to me that we ought to take the case of Risperdal as an admonitory example. There is no “magic pill” for autism. Medicine comes with side effects and is only the first step for the best “treatment”: Education of autistic children in ways most appropriate to their neurological wiring, learning styles, and their dignity.

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