Medication in Teenage Years: A Thoughtful Approach

Mental health concerns are common in autistic teens and often intensify during puberty when emotional dysregulation can become overwhelming. When parents feel overwhelmed by persistent meltdowns, aggression, or other challenging behaviors, and other supports seem insufficient, medication is often considered. This can occur in children as young as 12 years old for severe emotional distress or co-occurring conditions such as eating difficulties, severe anxiety, or persistent behavioral challenges.

The Concept of "Double Dosing"

A significant concern arises when medication is used to address challenges that stem from unmet developmental needs rather than genuine neurochemical imbalances. This phenomenon, called "double dosing," occurs when natural emotional responses are medicated away instead of being understood and supported through appropriate interventions. If emotional dysregulation stems from lack of appropriate emotional education, communication development, or opportunities for agency, then medication risks masking distress without resolving root causes. The most concerning scenario is when medication becomes a substitute for foundational skill-building that should have begun earlier.

Approaching Medication Thoughtfully

Use Medication as Part of a Holistic Plan

Medication should never be the first or only response to behavioral challenges. A thoughtful approach includes:

• Prioritizing emotional regulation support from an early age (ideally starting around five)
• Building communication skills so teens can express needs and exercise choice
• Including teens in decisions about their care to foster agency and self-advocacy

Address Underlying Needs, Not Just Symptoms

The need for medication often reflects gaps in emotional support, communication development, and opportunities for meaningful choice-making. Proactive approaches that address these areas can reduce reliance on medication.

Monitor and Review Regularly

• Medication should be prescribed and monitored by healthcare providers experienced in autism and adolescent mental health
• Regular follow-ups assess benefits, side effects, and changing needs
• Plans should remain flexible and responsive to the teen's development

Foster Communication and Independence

Daily conversations and involvement in decision-making help prevent accumulated frustration and behavioral challenges. Gradually shifting from making all decisions for teens to including them in choices about school, therapy, and daily routines supports emotional regulation and reduces the likelihood of crisis situations.

Medication and Conditional Independence

From a neurodiversity-affirming perspective, teenagers can be considered independent even when their functioning is supported by medication—as long as their voice and choices remain central. Independence becomes conditional, supported, and negotiated rather than absolute, but it remains equally valid and respectful of autistic lived experience. The key question is not whether medication eliminates independence but whether it creates space for the teen to operate with greater agency and engagement in their life.