Sensory overload: Teaching children with autism to take medication

In this article:

• Why do some children with autism dislike taking medication?
• How to teach a child with autism to take medicine
• Taking liquid medications
• Swallowing pillows
• Fear of needles and other phobias
• Monitoring and adjusting the approach
• Medication adherence

In this article

• Why do some children with autism dislike taking medication?
• How to teach a child with autism to take medicine
• Taking liquid medications
• Swallowing pillows
• Fear of needles and other phobias
• Monitoring and adjusting the approach
• Medication adherence

Whether it’s because they don’t like the taste of the liquid, are unable to swallow pills, or fear injections, some children struggle to take their medications. Children with autism spectrum disorders (ASD) may be even more overwhelmed or anxious about taking medication.  

This guide will explain why children with autism reject medication and provide tips for parents to make taking medicine as easy as possible.

Why do some children with autism dislike taking medication?

Medication refusal can happen on any day for any reason, but if your child consistently refuses medication, it may be helpful to understand why. It’s important to avoid blaming children and instead work with them to overcome their concerns.

Autism and anxiety disorders

According to the Anxiety and Depression Association of America, 40% of young people with autism spectrum disorder experience clinically significant anxiety or at least one anxiety-related condition, such as obsessive-compulsive disorder.

Anxiety disorders may be a reason for taking medication and a reason why your child refuses medication.

Sensitivity to tastes and textures

Studies show that food selectivity, aka “picky eating,” is common among children with autism. Food selectivity may be linked to heightened sensitivity to tastes and smells.

Children with autism may experience the world around them differently. A sound, sight, smell, texture, or taste that seems unremarkable to many may trigger extreme reactions. In other words, liquid medicine, chewable tablets, or gummies that seem fine to you might smell, feel, or taste disgusting to a child with autism.

Difficulty swallowing pills

Swallowing is a complex process requiring coordinated movements by the tongue, hard palate, and esophagus. Children diagnosed with ASD are more likely to have sensory-motor and coordination difficulties. Some aren’t able to activate the motor functions needed to swallow on command.

During the oral phase of swallowing, the tongue and hard palate must propel the medication toward the back of the throat. Once this happens, the swallow reflex should activate. If it doesn’t, children may cough, choke, spit up, or get the pill stuck in their throat.

Fear of needles and other fears

Phobias are some of the most frequent subtypes of anxiety disorders, which commonly co-occur with ASD. Children with autism are prone to common childhood fears (like fear of needles) and common food fears such as fear of vomiting, choking, or allergic reaction. They may also have uncommon fears which cause anxiety as well. One study found that 41% of children with autism had “unusual fears,” such as vacuum cleaners, toilets, and elevators.

Children with autism may fear the side effects of a medication, or they may associate the side effects of the medication with another fear. Since fear of the toilet is one of the more prevalent “uncommon” fears, a medication with digestive side effects such as vomiting or diarrhea may exacerbate that fear.

Resistance to change

Resistance to change is common among children with autism. Children may resist taking medication (especially a new one) because it interrupts their established routine. 

Before a doctor’s appointment, parents should inform their children that the healthcare provider may prescribe them medication that they may need to take. Telling them early will give them time to adjust and prepare for a change in their routine or schedule.

RELATED: Guide to sensory-friendly doctor visits for children with autism spectrum disorder

How to teach a child with autism to take medicine

There are several ways to teach a child with autism to take medication. Explore the different options to find a tactic that works for your child.

Gradual introduction and reduction of assistance

Gradual introduction (shaping) and gradual reduction of assistance (stimulus fading) are two effective methods for teaching children to swallow pills. Both involve gradual steps, starting with small items that your child likes, such as grains of rice or a tic-tac candy, and increasing the size until it matches the pill. Shaping focuses on building the skill step by step, while stimulus fading also reduces anxiety by ensuring the child is comfortable at every stage. Tailoring the approach to your child’s needs can make pill swallowing easier and less stressful.

Positive reinforcement

Maintaining a positive attitude and staying calm can help children also remain calm during events that may cause fear, such as taking medicine. The Autism Speaks organization explains that providing positive feedback more frequently than constructive or negative feedback can build self-esteem and improve motivation. When your child completes one of the steps above, provide positive verbal feedback or rewards like playing with a favorite toy or game. 

Visual and social stories

As with doctor’s appointments, visual and social stories are a great way to help prepare your child for what to expect when taking a pill. When reading the story, make sure to talk in a calm, measured voice and explain the sensations your child may experience. Many children’s television shows or online videos also have episodes centered around taking medication.

Modeling

Modeling shows children that the action you want them to take is easy and harmless. When children see a parent swallow a pill or take liquid medicine, they may feel less anxiety about doing it themselves.

Modeling may be beneficial for children with autism who struggle to understand spoken instructions. Seeing a person perform a task and then imitating the task may be a more effective way for them to learn. Keep pill-like objects on hand to model proper medicine-taking behavior.

Practice sessions

Ask your healthcare provider or pharmacist if they offer placebo pills in a similar size, shape, and color to the actual pill to give your child the chance to practice swallowing the pill. Have your child take the medication at the same time and location (home, school, etc.) where he or she will be taking the actual medication.

Special steps with liquid medication

In addition to the steps above, you may be able to introduce additives to make a liquid medication taste better.

Ask your pharmacist if it’s okay to mix the medication with water, juice, or another liquid that will mask the medication’s taste. Your pharmacist will be able to advise you about what drinks or foods to use that won’t interact with the medication. You should only use a small amount of additional liquid because you need to ensure your child ingests all the medication.

You may want to ask the pharmacist if they add any flavoring to liquid medication, which is a common practice. You might be able to request a flavor that your child prefers or avoid one they don’t like. Sometimes the added flavoring can be really strong and your child might prefer the liquid without the flavoring.

If your child refuses liquid medication, ask a medical professional if the same medication is available in a pill or chewable tablet form.

Special steps with pills

Ideally, the techniques above will allow your child to become more comfortable with swallowing a pill. If not, there are a few additional strategies to ask your child’s healthcare provider and pharmacist about. Note: Some medications should not be broken, crushed, cut, or dissolved.

Breaking or crushing pills, when safe

If deemed safe by your child’s healthcare provider or pharmacist, you can break, crush, or cut large pills into smaller pieces to make them easier to swallow. If it is safe to crush the pill, you may decide to blend it into a food such as applesauce or pudding. Some children who struggle to swallow pills have no problem taking the medication in a spoonful of yogurt, applesauce, or peanut butter.

Dissolving in liquid

It is sometimes possible to dissolve some pills in water or juice to make them more palatable to your child. If your child’s provider or pharmacist says it’s okay, you can crush the pill and stir it into your child’s favorite juice. If you can break or crush the pill safely, it will probably dissolve.

Precautions when performing these steps 

Always consult your physician and/or pharmacist to determine if breaking, crushing, or dissolving your child’s pills is acceptable. Some medications contain special coatings that release the medication over time. Breaking or crushing them may destroy this film, causing the medication to be released all at once.

If you’re adding medication to foods or liquids, make sure your child consumes the medication immediately after preparation. Don’t prepare large batches of food with medicine because the medication may degrade over time when crushed or removed from its protective packaging. Finally, never bake medicines into food.

Pill-swallowing techniques

• Lean-forward method: Place the capsule on your child’s tongue and have them take a sip of water without swallowing. Tell your child to tilt their chin toward their chest and then swallow.
• Two-gulp method: After your child places the pill on their tongue, have your child swallow one gulp of water without swallowing the pill. Then, immediately ask your child to take a second gulp to swallow the pill.
• Straw technique: Place the pill far back on the tongue. Have your child drink a beverage through a straw. If your child is focused on swallowing their favorite beverage, they will likely swallow the pill without thinking about it.
• Pop-bottle method: Place the pill anywhere in the mouth. Have your child seal their lips over an open drink bottle. Tell your child to maintain contact with the bottle while taking a big gulp of the drink. This should allow your child to easily swallow the pill.

Dealing with fear of needles and other common phobias

Needle phobia is not unique to children with autism, but the condition does present additional complexities in people with autism.

Distraction and relaxation techniques

Distraction pulls your child’s attention away from the needle and toward something else. Research has shown that this is an effective method for reducing pain and unpleasantness. There are some recommended techniques to use depending on your child’s age:

• 6 to 24 months: Rhymes, kaleidoscopes, or musical toys
• 2 to 5 years: Simple visual or auditory stimuli like blowing bubbles, counting, and story reading
• 5 years and older: Guided imagery (helping your child imagine they are somewhere else), playing video games, or watching a video.

Desensitization for needle phobia

A child psychologist can perform desensitization to help improve your child’s needle phobia. This process involves gradually introducing a needle in a non-threatening way, such as first allowing the child to hold the syringe without a needle, then introducing a capped needle, and finally presenting a fully assembled syringe.

Monitoring and adjusting the approach

If your child isn’t adjusting to taking medication, there are a few additional steps to take.

Tracking progress

Keep a record of whether your child has successfully taken their medication. You may find it helpful to keep a written or visual record of your child’s attempts and to celebrate progress. A chart (PDF) is a great way to keep track of how far your child has progressed, especially with pills.

Small victories are important! It may take days to weeks until your child feels confident enough to swallow the medication. Reward your child for his or her attempts and successes along the way. Each time your child attempts to take the medication, give them a sticker to place on the chart, including if the attempt is unsuccessful. Continue to fill in the chart until your child can successfully swallow the medication. Even after your child has taken the medication once, provide positive reinforcement for all future attempts to encourage your child to continue taking the medication.

Making adjustments

If you are facing problems with injections, consider whether the healthcare setting is making things difficult. You may decide to travel to a more child-friendly clinical setting, such as a small pediatrician’s office, instead of going to a large hospital.

You may also want to ask your child’s healthcare provider if the medicine comes in any other forms or flavors or if a licensed compounding pharmacy can alter the medication to make it easier for your child to take, such as by adding flavoring. Also, ask their healthcare provider if they can dose the medication as infrequently as possible, like prescribing once-a-day dosing instead of twice a day.

Involving healthcare professionals

If you feel overwhelmed or your child is not responding to the techniques above, it may be necessary to involve a healthcare professional, such as a child psychologist. In addition to helping children overcome their fear of needles, psychologists can help children learn to swallow pills. Although many children find success after only one session, some may need several sessions before they are ready to have a real injection or swallow a pill on their own.

The importance of medication adherence in children with autism

There are several reasons why medication adherence is important for children with autism.

Physical health

Medication adherence is the most critical factor for the success of any drug therapy. When children don’t take their medication, they take longer to feel better and may even feel worse. Failure to adhere to a drug regimen may jeopardize your child’s health and create more stress, especially if a condition worsens and requires a doctor’s visit or even more medication. Explain to your children that sticking to their medication regimen is critical for their health and will probably decrease the chance of future visits to the doctor.

Psychological and social benefits

Medication adherence may be critical to your child’s psychological and social well-being. A healthcare provider may prescribe medication to help children address issues such as irritability, anxiety, aggressive behavior, hyperactivity, and sleep problems. Behavioral issues may keep your child from engaging in social activities, such as spending time with friends or going out to eat at a restaurant. Therefore, taking medication may allow your child to engage in social interactions and help your child participate in activities that are critical for his or her social and psychological development.