When A Child with Autism Will Not Take Medicine

Today’s video blog is all about when a child with autism will not take medicine. 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. 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 often face with their children with autism.

When Lucas was a baby, we could put liquid medicine – such as infant Ibuprofen – directly into his mouth. And since the infant medicine was flavored and it was a small amount in a dropper, 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 for him to take.

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 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.

Administering Medications

Shortly after Lucas’ diagnosis, we crushed up vitamins and supplements and any prescription medications and put them in applesauce. We fed him one spoonful of the mixture followed usually by an 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. 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. The only way to make it go better was to teach Lucas to swallow pills.

Some parents mix everything into juice. But I couldn’t because Lucas never liked juice and it was impossible to disguise the taste in water. Also, giving medications in juice was not the answer either. 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. There are some medicines that are really bitter-tasting and gross. And there are some meds that are in time-release capsules that can’t be crushed.

When a Child with Autism Will Not Take Medicine

As a child with autism becomes older, it becomes increasingly difficult to administer medications, especially if your child isn’t taking pills.

I attended a few lectures on pill swallowing and learned how to teach this skill. Coupled with my nursing background, I have been successful in teaching kids with autism to swallow pills, including Lucas.

I got Lucas to start swallowing pills when he was on prednisone for 21 days. He needed to treat a flare-up of his autoimmune disorder. In hindsight, I should have taught Lucas to swallow pills a lot sooner. When the doctor prescribed the medicine, he said the pill was very nasty-tasting. The doctor warned me 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 pill into the applesauce without Lucas seeing me do it at first.

Actually, the prednisone pill was so little that it just slid right down without Lucas even noticing. Since Lucas was used to eating 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.

How to Start Teaching a Child to Swallow Pills

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 use a tiny piece of rice, or the smallest little bean you can find.

Some people recommend starting with Tic Tac or other candy. But that’s probably not a good idea. Tic Tacs and candy have a taste to them and you don’t want the child chewing or tasting it. 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 reinforcer. You can also use video modeling where you record the same action that you want the child to imitate.

For the applesauce method, dunk a piece of rice in applesauce and give a spoonful 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 have 3 trials of being able to swallow rice or orzo, then go up in size to a small bean. Of course, you’ve got to give the child major reinforcement for each of these steps.

Moving Forward

Once your child can swallow pills, it might be time for them to be independent with taking medicine from pre-poured containers. And/or respond 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.

To learn more about how you can help your child or client with autism, and more about when a child with autism will not take medicine, take a free workshop by going to www.marybarbera.com/workshop.