re: Medication for Autistic Meltdowns?

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when they’re potentially building up to an outburst.

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This can be challenging at times. Sometimes they seem to happen at the drop of a dime, and it's hard to determine what the antecedent is that triggered the behavior.

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1. How often do the meltdowns occur?
2. How long do they last?
3. Is there a specific precipitate to the outbursts? Has the ABA therapist identified a common trigger? (Like being blocked from completing a sequence or stimming behavior)

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1. I'd say on average 2-3 times a week.

2. Anywhere from 30 minutes to an hour.

3. We are familiar with ABC (Antecedent, Behavior, Consequence) but we haven't charted it out lately.

I guess that is a very important aspect, the trigger. But sometimes they seem like they happen so quickly and without reason that it's hard to determine the trigger.

We do and have worked with ABA therapists. It has been extremely beneficial. Sometimes even they are dumbfounded as to what the trigger is.

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1. I'd say on average 2-3 times a week.

2. Anywhere from 30 minutes to an hour.

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Thanks. One other question. How “out of control” are the outbursts? Safety concerns like head banging or biting self? Attacking others?

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How “out of control” are the outbursts? Safety concerns like head banging or biting self? Attacking others?

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Biting himself and hitting, scratching, and biting others. He throws things.

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A belt?

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Trust me, it doesn't work.

Stay strong, Dad. Can't imagine the emotions you're going through and we all wish you the very best.

My son was/is on the sensory processing wonkines, but it’s turned into a bit of a gift. Just embrace the craziness and love the little guy.

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Stay strong, Dad. Can't imagine the emotions you're going through and we all wish you the very best.

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Thank y'all for this.

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Biting himself and hitting, scratching, and biting others. He throws things.

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Ok. Just making sure there is an actual need for medication. Too many parents use medications for yelling and stomping around which does not meet risk benefit criteria in my mind.

The difficulty with using PRN meds for these types of outbursts are:
- any medication you use will take 5 mins to administer and 10-15 mins to start working and now you almost over the outburst (if it’s 30 mins).
- It’s hard to get someone to swallow a medication when they are agitated (as you have said).

You have three options:
1. Placing the child on a maintenance medication like an SSRI (preferred), a Dopamine based medication like Abilify (second line) or an old tricyclic (clomipramine) to target the obsessions and anxiety that lead to the outbursts.
2. Using an “as needed medication” but not just for the “bad outbursts” but to use at the first sign of agitation since you can never predict when agitation will resolve or when it will progress to a meltdown. Medication choices include Hydroxyzine (similar to Benadryl and very safe), Risperdal (has a liquid and ODT form) or Abilify (has an ODT), and [IMO last choice] benzodiazepines like Valium or Ativan. The reason benzos are last options is the frequency with which you will need to administer. You do not want to develop tolerance and then deal with benzo withdrawal in an autistic child.
3. CBD oils. Very safe. Virtually zero side effects. Not addictive. Must be used daily. Only downside is poor overall efficacy. (A large number of kids don’t respond - but those that do respond have great success.

One other main point is that no matter what medication you choose - you are not agreeing to any form of treatment for years. You should only use the treatment for 6 months and then slowly taper to see if the medication is still needed (even CBD oil). If the symptoms return, you go back on the treatment and then plan to taper again.

Your child is developing rapidly and symptoms can improve dramatically as they age. You have to (1-2 times per year) check to make sure they still need the medication.

I should have also added that I would start with:

Hydroxyzine PRN for meltdowns while you start CBD and get it up to therapeutic levels. (If it works, then no need to continue the Hydroxyzine.)