Intended for healthcare professionals

Clinical Review

Diagnosis of autism

BMJ 2003; 327 doi: (Published 28 August 2003) Cite this as: BMJ 2003;327:488

Psychotropic drugs for children with autism

There seems very little enthusiasm for the professionals to connect
autism to brain damage. I have previously shown how they are related. If
brain damage has some connection with individuals who have autism or show
aspects of the condition, then should they be prescribing psychotropic
drugs as suggested by Dr P V Finn Cosgrove? Clinical trials of these drugs
have not included children or those with brain damage.

My daughter was placed on psychotropic drugs at the age of ten years.
This was because the psychiatrists who ‘control’ those with ‘learning
disabilities’, could not see beyond the ends of their noses. They had no
conception what it was like to be brain-damaged at five months of age; or
of what the neurological consequences might have been. Nor did they stop
to wonder for a moment what the effect of these drugs might be on one
whose neurological functioning was abnormal.

I sometimes wonder what it is really like to be the person who is my
daughter. In a world that has robbed her of many of the connections that
we expect to have in place, she has to find some solid ground on which she
can walk with certainty. She is unable to create this for herself and
relies entirely on others for her safety, security and peace of mind. Yet,
constantly, the ground is dug out from under her feet and she finds
herself falling, she grabs at anything that might keep her upright and
doing so may well pull other things down. Then she has to say sorry for
things that she can’t help, without knowing how not to have them happen

The fear of rejection or abandonment is around every corner, yet she
is not able to determine how to prevent it. Sleep for her might be a haven
of peace, the only place in the day where she does not have to worry about
what people think or how they might react. But even this haven, this
single place that we all believe to be a right, is taken from her by the
forces of medication. She finds her day to be at a divergence from that of
others, a bizarre collection of hours that have no connection.

She seeks release in things that are soothing and repetitive and this
then becomes a circle of entrapment, a rotating disc, the movement of
which, at first enjoyable, becomes a sinister whirligig from which there
is no escape except by someone who recognises her plight and changes the
path. Everyday she must wonder what she has to do to get things right and
every day she finds there is no answer. Pleasures are peripheral and
always at someone else’s whim or design. She can never plan for tomorrow
because tomorrow is as far off for her as next year or next century. All
she has are her memories of the past and so many of them have been bad

She makes constant demands upon all of those around her, demands that
do not originate from selfishness but as a result of her brain damage;
from the denial of an ability to do things for herself, to be autonomous.
In having to rely so much upon others she becomes an instrument for them
on which to practice. They are not judges, as she is, whether they get
things right. So, right or wrong she has to submit to interpretations of
her desires and live with whatever results.

Competing interests:
Father of a daughter who has brain damage and autism

Competing interests: No competing interests

01 November 2004
Alan Challoner MA (Phil) MChS
LL18 5UR