Dr. Feder has a lot of experience in the world of autism. He was in on the first practice parameters for diagnosing and management of autism from the American Academy of Child and Adolescent Psychiatry in 1999, and sits on a policy working group related to autism and intellectual disabilities, having been in discussions about autism and medication for decades.
Dr. Feder has conducted neutral, non-industry based pharmaceutical research funded by the
National Institutes of Health (NIH), and is editor and chief of the Carlat Child Psychiatry Report, a non-pharma and transparency-based newsletter and continuing education vehicle for child psychiatrists, helping craft training for child psychiatry in the use of medications.
The Role of Medication
Dr. Feder sees medications as a tool to support a good plan, not to try to make up for an inadequate a plan, which is DIR thinking. He notes that many people are always concerned about the safety of medications and side effects, but people should also be skeptical of many supplements out there which may not be safe. A lot is known about medication and side effects whereas not so much research is out there about some supplements and other substances.
He gives the example of CBD (Cannabidiol from marjuana). There is a lot of hype and marketing but not a lot of solid evidence to support that it works. There is, however, a lot of evidence to support many problems associated with it, and now that people are using it more and more, there are more reports of adverse side effects.
Regression to the Mean and Placebo Effects
Dr. Feder describes how you can start a medication and your symptoms might go away, but it is not necessarily due to the medication. Lots of times symptoms wax and wane. When they get worse and we do something to try to help them and they improve, they might have already peaked anyway. You need to really monitor over time what works, or you could be taking medication that might not be helping. Also, placebo effects may help you feel better regardless of what the medication is doing, but they usually don’t last more than a few weeks.