Improving Adherence for Children with Autism Spectrum Disorder

Cheri Garvin, RPh, President and CEO The Compounding Center in Leesburg, VA

I have been a compounding pharmacist for the past 28 years, co-owner of The Compounding Center in Leesburg, VA since 2009, and a MEDISCA customer for over 20 years. While many organizations spent April elevating National Autism Awareness Month, this is an area our pharmacy focuses on year round. A countless number of people don’t know this, but many patients with Autism Spectrum Disorder (ASD) rely on compounded medications due to a variety of issues, including sensory complications, trouble swallowing pills, ingredients that cause irritation or allergic reactions, and more.

Managing medications for a child with ASD can be especially challenging. Many children on the spectrum can be hyper sensitive to flavor and texture. My team works closely with the parents of our patients with ASD, and their physicians, to ensure they are receiving effective medications that are tailored to their specific, individual needs. In many cases, we compound medications into a liquid form with better tasting flavors- including combinations like chocolate/cherry flavor- so it’s easier to administer the medication. Sometimes we are tasked with creating dye-free or gluten-free liquids, or perhaps a topical cream. In one case, we concentrated a suspension of a behavioral medication for a child so they didn’t have to take a large quantity of the medication. The mother was better able to hide it in sugar-free applesauce.

We like to offer flavor choices to the children. One of my patients, a non-verbal child with ASD, was able to point to the picture of the fruits and tell us what flavor he preferred. I think because he chose his medication flavor, it gave him a feeling of control over his medications and he was more willing to take them.

Here are some things to consider when compounding medications for patients with ASD:

  • Dosing considerations – many drugs are commercially available for adults, but a lower dose or liquid formulations may not be available for children.
  • Unwanted additives – many parents are trying to avoid sugars, dyes, casein and gluten for their children with ASD.
  • Taste – some patients may be hyper sensitive to flavors or sweetness. In these cases, you need to work closely with parents and be willing to help them experiment.
  • Texture/Mouth Feel – how thick or gooey a medication is can affect administration and adherence.
  • Alternative dosage forms – we can compound gummies or lollipops, but sometimes this may not be the best option if the drug is bitter. Sometimes having the medication sit in the mouth longer makes it worse. A “down the hatch” mentality may be better for bitter drugs. Also, using something that coats the tongue right before the dose can help. You should also consider whether or not the drug can be administered through a transdermal application.

Overall, creating customized medications for patients with ASD requires communication with the parents and the patient about their needs. Keep in mind that being willing to try different options is also necessary. You can learn more about compounded medications for patients with ASD and The Compounding Center at https://www.compoundingcenter.com/ .

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