When A Child with Autism Will Not Take Medicine

Hi, I’m Dr. Mary Barbara, autism mom and board-certified behavior analyst. Today’s short video blog is going to answer the question: How do you teach a child with autism to take medication? As you probably know, I’m a behavior analyst and a mom to two adult sons, one with autism. Some of you may not know that I’ve also been a registered nurse for over three decades, and I 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 and staff members often face when working with children and clients with autism. Medication Administration When Lucas was a baby, we could put liquid medicines such as infant ibuprofen directly into his mouth. But as he got older, the required volume of liquid medicine became harder to manage, and many medications weren’t available in liquid form. Shortly after Lucas’s diagnosis at age three, we began crushing vitamins, supplements, and any prescription medications, mixing them into applesauce, and spoon-feeding them to him—one spoonful of the concoction followed by an edible reinforcement, then another spoonful, and so on. At times, this worked fine, but many times it was nasty. Lucas became resistant and exhibited problem behaviors around medication time. I asked another BCBA to observe me giving Lucas his medicines when he was about five years old. She told me that crushing pills made them smell and taste really bad, and that the only long-term solution would be to teach Lucas to swallow pills. Some parents mix medicine into juice, but that wasn’t an option for us because Lucas never liked juice. Even when parents do this, the medicine often settles at the bottom, making dosage unreliable. Disguising medicine in food or drinks isn’t a good solution, especially for picky eaters, and some medications (like omega-3s or time-release capsules) can’t be crushed. Over the years, I attended lectures on pill swallowing and learned how to teach the skill using systematic desensitization and stimulus fading—gradually increasing pill size—along with modeling and reinforcement. My Experience I successfully taught Lucas to swallow pills when he was prescribed prednisone at age 14 for an autoimmune flare-up. The doctor warned me that prednisone pills were especially bitter and would be disgusting if crushed. He suggested dunking the very small pill into applesauce without Lucas noticing. It worked—the pill slid right down. From there, we systematically increased the pill size and began showing Lucas what we were doing, so it was clear this was medicine time and not hidden food. We always paired medicine-taking with reinforcement. Today, Lucas can swallow large capsules, though he still prefers to take them with applesauce. If your child is comfortable swallowing water from an open cup, that’s a great place to start. Use very small items such as a grain of rice, a tiny piece of pasta, or a small bean. Avoid candy like Tic Tacs because of the taste and the risk of chewing. Gradually increase the size of the item while reinforcing success at each step. You can model the process directly (“watch mom take a big gulp of water”), practice with small items, or even use video modeling if your child responds better to watching a screen. If you prefer the applesauce method, dunk something tiny (like rice or pasta), offer it, and reinforce. As success builds, increase the size and eventually use real medicine while showing the child it’s part of the routine. Building Independence Once a child can swallow pills, it may be time to increase independence with medication. This could mean taking medicine from pre-poured containers, using timers, or following visual schedules. While many individuals with autism may always need supervision for medication administration, others can become more independent with the right supports. These ABA-based strategies can improve your child’s or client’s acceptance of medication. If your child has serious medical issues, swallowing difficulties, or problem behaviors around medication, a thorough assessment and individualized plan are essential. I hope you found this overview helpful, and I’ll see you next week.