Today’s video blog is going to answer the question, “How do you teach a child with autism to take medication?”
As you know, I’m a behavior analyst and a mom to 2 adult sons, one with autism. Some of you may not know that I’ve also been a Registered Nurse for over 3 decades and feel that my nursing background has been extremely helpful in working within the autism field.
Because of my background and experience, I feel qualified to answer questions about medication administration and the unique issues parents often face with their children with autism.
When Lucas was a baby, we could put liquid medicine such as infant Ibuprofin directly into his mouth and since the infant medicine was flavored and, since it was a small amount in a dropper and Lucas was so little, he usually took that without too many issues. But as Lucas got older, the volumes of liquid Ibuprofen required for his larger size became a lot more difficult.
Because Lucas was a very picky eater and was underweight when he was just diagnosed at the age of 3, it was recommended that we give him multivitamins and other supplements like omega 3s every day. Sometimes, when he was ill, we also needed to give him antibiotics or other medications to treat infections and illnesses. Also, over the years, we tried various prescription medications to help him sleep better and to treat other issues related to his autism as well as for his autoimmune condition which we learned about when he was 6 and his autonomic nervous system dysfunction which we started treating when Lucas was a teen.
Shortly after Lucas’ diagnosis at the age of 3, we would crush up vitamins and supplements and any prescription medications, put them in applesauce, and feed him one spoonful of the mixture followed usually by an edible reinforcer and then another spoonful of the crushed up vitamins and supplements in applesauce followed by another edible reinforcer. At times, the concoction was nasty and Lucas became resistant and exhibited problem behaviors around medication time.
I asked another BCBA to watch me give Lucas his vitamins and medicines when he was around 5 years of age as I was looking for ideas on how to have Lucas take the medicines without problem behaviors. She basically told me that crushing the pills made the concoction smell (and probably taste) really bad and that the only way to make it go better was to teach Lucas to swallow pills. Some parents mix everything into juice which I couldn’t do because Lucas never liked juice and it was impossible to disguise the taste in water. I also saw over the years as a BCBA that giving medications in juice was not the answer either since it may take the child a long time to finish the juice thus affecting the time of the dose, the meds could all settle at the bottom of the cup, and many times, especially if the meds were in juice, the parent couldn’t be sure how much of the medication the child actually ingested.
Trying to disguise medicine crushed and put in food or drinks is not a great solution and not a long-term solution since there are some medicines such as Omega 3s that are really bitter-tasting and gross and there are some meds that are in time release capsules that can’t be crushed.
I learned very early on that as a child with autism becomes older, it becomes increasingly difficult to administer medications, supplements or vitamins if your child isn’t taking pills.
I attended a few lectures on pill swallowing and learned how to teach this skill using systematic desensitization procedures and stimulus fading in of more difficult demands (or in this case making the pill size gradually larger) as well as modeling and reinforcement. Coupled with my nursing background, I have been successful with teaching kids with autism to swallow pills, including Lucas.
I got Lucas to start swallowing pills when he was on prednisone for 21 days to treat a flare up of his autoimmune disorder. Lucas was 14 at the time this medication was prescribed and, in hindsight, I should have taught Lucas to swallow pills a lot sooner. When the doctor prescribed prednisone, he said that the prednisone pill was very nasty-tasting. The doctor warned me that If I crushed it up, it would be disgusting.
Because I told the doctor I was giving Lucas other things crushed up in applesauce; he advised me to just dunk the small prednisone pill—it was very little—into the applesauce without Lucas seeing me do it at first, and then just give it to him with the pills.
Actually, the predisone pill was so little that it just slid right down without Lucas even noticing. Since Lucas was used to taking applesauce, we systematically started increasing the size of the pills. Also, we started showing him that we were dunking the pills in the applesauce followed by giving him reinforcement.
Now, Lucas can take large capsules, but he only takes them in applesauce.
If your child is okay with just swallowing a gulp of water from an open cup, that’s where I’d start. Then I would systematically, like the lectures I’ve seen, start with even just a piece of rice, or the smallest little bean you can find, or something like an orzo pasta.
Some people recommend starting with Tic Tac or other candy, but that’s probably not a good idea because that has a taste to it and you don’t want the child chewing on candy or experiencing the taste. That’s why using beans, rice, or pasta; and then systematically increasing the size of it with a strong reinforcement is the way to go.
For some kids you can model directly: “Watch mom take a big gulp of water!” Then have the child imitate. Next: “Watch mom put this rice on my tongue!” Followed by a gulp of water. Then have the child imitate and give a reinforcement. You can also use video modeling where you record the same action that you want the child to imitate.
If, like Lucas, you’re more eager to try the ͞applesauce method, get the applesauce, dunk something small like the orzo pasta or a piece of rice and give the spoon of applesauce to the child then reinforce. After each step is successful, systematically start showing your child or client that you are giving him medicine. Once they would have 3 trials of being able to swallow rice, for example, then you go up to a very small orzo pasta, and then to a very small bean. Of course, you’ve got to give the child major reinforcement for each of these steps.
Once your child can swallow pills, then it might be time to have the child, teen or adult to be independent with taking medicine from pre-poured containers and/or responding to timers or a visual schedule to take the correct medication at prescribed times.
These are some proven ABA strategies to try to improve your child or client’s acceptance of medication. If your child or client has any serious medical issues, swallowing difficulties, or problem behaviors surrounding medication administration, he or she will need a thorough assessment and individualized programming to treat these issues. I hope you found this overview helpful and I’ll see you next week!