I have often been asked about subjects that should be discussed in autism support groups. Proper nutrition, the importance of fiber in a diet, dental hygiene, exercise, obesity, and the prompt diagnoses of comorbidities certainly come to mind. These subjects can all be discussed by parents with little help from external support. There are, however, three subjects of extreme importance for which I would invite guest speakers. One is sexual abuse (the object of a previous blog), another is the dangers of polypharmacy, and the other is accidental ingestion.
Given the current circumstances with the coronavirus and quarantined families I think discussing accidental ingestion may be life saving. Indeed, as the coronavirus has spread throughout our nation poison hotlines have experienced an exponential increase in call-ins. It may be that the overabundance of cleaning products and the lack of precautions as to their safekeeping have posed a tremendous challenge to our society. As I tell our families, as long as you have a child who is mobile, curious, and has a mouth, you are at a high risk for accidental ingestion.
Although I am not aware of prevalence studies regarding accidental ingestion in autism, there are numerous case reports indicating that this is a common occurrence. A quick search in Google using the terms “accidental ingestion” and autism reveals 798,000 results. The search findings include titles of articles such as “Management of a patient with autism following ingestion of a foreign body” and “Acute oxcarbazepine overdose in an autistic boy”. These case stories have several commonalities: First, and as expected, direct communication between the medical personal and patient is limited. It is said that as many as 40% of autistic individuals are nonverbal. This makes history taking rather difficult. In addition, the majority of patients after accidental ingestions are usually brought in to the Emergency Room after parents notice a change in behavior. The vague complaint being, he/she was not acting this way until a few days ago.
The majority of accidental ingestions are unintentional. A significant minority, however, are “therapeutic errors”. Autistic children are followed by multiple physicians who are often unaware of all of their individual efforts. One third of autistic children receive multiple prescribed medications for seizures, attention-deficit disorders, anxiety, bipolar disorder, etc. Many of these patients live within a vicious cycle wherein abnormal behavioral profiles (e.g., aggression, forced institutionalization) predict the use of polypharmacy and vice versa (i.e., the use of polypharmacy may actually compound maladaptive behaviors). I have found that marked exacerbation of stereotypies usually rides the coattails of comorbidities. For some patients, stereotypies resemble animal behaviors in a caged environment and as such are probably meant to liberate stress, an attempt at saying that something is wrong.
According to the CDC unintentional poisoning is the leading cause of death for all age groups. Since 2009, it has surpassed motor vehicle fatalities as the leading cause of injury death in the USA. The most common ingestions are cosmetics and personal care products (e.g., shampoo, toothpaste, makeup). According to GoodRx some of the most common medications that physicians uncover in children overdoses are blood pressure and diabetes medications, Tylenol and aspirin.
If you suspect an accidental ingestions call your poison control center or the national hotline: 1-800-222-1222. A useful web site for consultation is https://triage.webpoisoncontrol.org/#/exclusions There are pill identifier wizards on the web, e.g., https://www.webmd.com/pill-identification/default.htm You enter the shape, color, or imprint of your prescription of OTC drug and the pill finder will display a picture that you can compare to your pill. As you talk to your physician be ready to provide information: dosage, number of pills, time of ingestion, and any other potential co-ingestions.
I would encourage in future support meeting to distribute the small brochure from SafeKids: Medicine Safety for Children: An In-Depth Look at Calls to Poison Centers. The same can be obtained from safekids.org. Remember the following:
Most accidental ingestions occur when parents or caregivers are at home. It is just difficult to keep an eye on all children at once and all of the time.
Store all potentially dangerous substances in their original packaging in locked cabinets or containers. Out of sight and out of reach of children.
Install safety latches to cabinets/doors to keep children away from dangerous products.
Purchase and keep all medication in containers with safety caps.
Never refer to medicine as “candy”!!!!
Check the label each time you give your child medicine to ensure proper dosage.
Never place poisonous products in food or drink products, e.g. antifreeze in Gatorade bottle.
Casanova MF. Autism Updated: Symptoms, Treatments and Controversies. Amazon Publishing, 2019.