You’re probably wondering where the next installment of the book is—and whether I fell off the planet!
I’ve been working behind the scenes to finish up Chapter 2 and get your free 85-page booklet on developmental optometry ready but had a bit of a delay. (it will be out in a few days, I promise!)
While We’re WaitingAfter exploring how vision and underlying health challenges factor into driving readiness in the previous chapter, let’s take a peek at a critical but often overlooked factor: Chapter 3:Medications: What You Need to Know.
It’s not a good idea to have a cocktail before hitting the road—but that’s often what happens with autistic teens and adults—a drug cocktail, that is!
A large population-based study¹ of over 30,000 individuals with ASD under age 21 found that at least 35 percent had taken two psychotropic medications at the same time, and 15 percent had taken three. In my experience with patients at my clinic, I’d say that is a very conservative estimate.
Polypharmacy
Polypharmacy—taking multiple prescription medications at the same time—is common on the autism spectrum, and there are several reasons why.
First, there are no universally accepted guidelines for “treating” autism, and doctors end up prescribing medications for individual symptoms and conditions like irritability, ADHD, depression, anxiety, seizures and disrupted sleep patterns.
Second, children and adults on the spectrum tend to be medically complex and have higher rates of co-occurring psychiatric conditions than the general population. The same study mentioned above found that 95% of youth with ASD had three or more comorbid psychiatric disorders, and 74% had five or more. Medications end up being prescribed for each condition.
While these medications can be essential and life-changing when appropriately prescribed, keep in mind that this is an older study, and as both science and clinical experience evolve, we’re learning that some behaviors may have underlying biological drivers—not just behavioral ones. Medications are often prescribed to manage symptoms, but they don’t always address root causes.
Our Story
We saw this firsthand with one of our sons. Years ago, in the late 2000s, we brought him to a renowned out-of-state autism center for an evaluation due to his challenging behaviors. We were told he would need a “severe behavior plan,” estimated to cost at least $100,000 to implement. It was all about behavior and how to control it, not a word was mentioned about possible underlying medical factors driving the behaviors.
Ultimately, we pursued a different path. With medical guidance, we implemented targeted gastrointestinal support, including dietary changes and digestive enzymes containing DPP-IV. To our surprise, this led to an approximately 80% reduction in his most challenging behaviors.
At the time, the gut–brain connection was not widely understood nor emphasized in mainstream clinical practice. The gut–brain connection is no longer fringe, but it’s still nuanced . While research in this area is still evolving, our experience highlights an important point: for some individuals, underlying biological factors—such as gastrointestinal issues—may significantly influence behavior. I’ve seen that in the majority of my patients for years. (and which is why I felt compelled to write The Un-Prescription for Autism!)
Back to the Polypharmacy Discussion…
In addition, autistic children and adults often see multiple doctors, each prescribing within their area of expertise, without a single provider coordinating the overall medication plan.
It’s also not uncommon for one medication to be prescribed to counteract the side effects of another—further increasing the overall medication burden. I’ve seen this not only in our own family, but many, many times in patients at my clinic.
And yet another layer: while supplements such as CBD, hemp extract, and medical marijuana are increasingly used—often with reported benefits—research shows they can interact with many psychiatric medications by altering how they are metabolized in the body. In some cases, this can increase side effects or even lead to medication toxicity.
I have questions!
How does all this affect:
- driving ability?
- reaction time?
- executive functioning?
It seems like science isn’t there yet for me on this one. Large-scale studies on the combined use of CBD and psychiatric medications—especially in complex cases involving multiple medications—are still limited.
PDIs (potentially driver-impairing drugs)
This chapter explores how PDIs (potentially driver-impairing drugs) might affect our brain, alertness, blood sugar levels, coordination, decision-making ability, and even our vision. Autism parents and autistic teens and adults will need the honest discussion this chapter provides on a known reality—polypharmacy on the autism spectrum—as they evaluate their readiness to drive. And it’s going to come down to this: are the medications helping, hindering, or unintentionally impairing the ability to drive safely?
This distinction matters when evaluating driving readiness—because addressing underlying issues may, in some cases, reduce reliance on medications that impair alertness and coordination. (I know I’m beating that health and vision drum again, but the most basic and valuable tools for reducing reliance on as many medications as possible can be found in Chapter 2.)
Next time I’ll have your free developmental optometry booklet ready, and we’ll dive into how medications may affect your driving readiness and skills!
Want to See the Research?
- The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. Joshi G, Petty C, Wozniak J, Henin A, Fried R, Galdo M, Kotarski M, Walls S, Biederman J. J Autism Dev Disord. 2010;40(11):1361–1370. Published 2010 Mar 23.