Phototherapy (also called “light therapy”), which involves exposure to artificial light, is quickly becoming a popular way to treat seasonal affective disorder (SAD) in children on the autism spectrum. SAD is a type of depression that occurs at a certain time each year, usually in the fall or winter. During phototherapy, your child sits near a device called a light box. The box gives off bright light that mimics natural outdoor light.
Phototherapy is thought to affect brain chemicals linked to mood, easing SAD symptoms. Using a light box may also help with other types of depression, sleep disorders and other conditions. You may want to try phototherapy on your child for a number of reasons:
- If the child is on medication for depression, it may allow him or her to take a lower dose of antidepressant
- It's a proven treatment for SAD
- If the child has another condition (e.g., OCD, anxiety, insomnia)
- If you want to try a treatment method that is safe and has few side effects
Phototherapy is generally safe. If side effects occur, they're usually mild and short lasting, and may include eyestrain, headache, agitation and nausea. When side effects do occur, they may go away on their own within a few days of starting phototherapy. Parents also may be able to manage side effects by reducing treatment time, moving the child farther from the light box, allowing the child to take breaks during long sessions, or changing the time of day he or she uses phototherapy.
It's always a good idea to talk to your physician before starting phototherapy, but it's especially important if your child:
- takes medications that increase sensitivity to sunlight (e.g., certain antibiotics, anti-inflammatories, St. John's Wort)
- has an eye condition that makes his or her eyes vulnerable to light damage
- has a history of skin cancer
- has a condition that makes the skin especially sensitive to light (e.g., systemic lupus erythematosus)
Light boxes should be designed to filter out harmful ultraviolet (UV) light, but some may not filter it all out. This type of light can cause skin and eye damage. Thus, look for a light box that emits as little UV light as possible. If you have concerns about phototherapy and your child’s skin, talk to a dermatologist.
Internet retailers, drugstores, and even some hardware stores offer a variety of light boxes. Also, your physician may recommend a particular model. Health insurance companies rarely cover the cost. Talk with your physician about the best light box for your family, and familiarize yourself with the variety of features and options to help ensure that you buy a high-quality product that's safe and effective.
Generally, most children with SAD begin treatment with phototherapy in the early fall when it typically becomes cloudy in many regions of the country. Treatment usually continues until spring when outdoor light alone is sufficient to sustain a good mood and higher levels of energy.
If your child typically has fall and winter mood problems, behavioral issues or depression, you may notice symptoms during prolonged periods of cloudy or rainy weather during other seasons. You and your physician can adjust the light treatment based on the timing and duration of your child’s symptoms.
During phototherapy sessions, your child will sit near the light box. Many children use this time to complete homework. To be effective, light from the box must enter the eyes indirectly. Your child can't get the same effect merely by exposing his or her skin to the light. While the eyes must be open, your child should not look directly at the light, because the bright light can damage the eyes. Be sure to follow your physician’s recommendations as well as the manufacturer's directions.
Phototherapy is most effective when your child has the proper combination of (a) timing, (b) light intensity, and (c) duration:
- Timing: For most children, phototherapy is most effective when it's done early in the morning after they first wake up. Your physician can help you find a therapeutic schedule that works best for your child.
- Intensity: The intensity of the light box is recorded in lux, which is a measure of the amount of light received at a specific distance from the light source. Light boxes usually produce between 2,500 lux and 10,000 lux. The intensity of the light box affects how far the child sits from it and the length of time he or she needs to use it. A 10,000-lux light box usually requires 30-minute sessions, while a 2,500-lux light box may require 2-hour sessions.
- Duration: When the child first starts phototherapy, your physician may recommend treatment for shorter periods of time (e.g., 15 minutes). Your child gradually works up to longer periods. Eventually, therapy typically involves daily sessions ranging from 30 minutes to two hours depending on the light box's intensity.
Since phototherapy requires time and consistency, you should set the light box on a table or desk. In this way, your child can read, use a computer, study, watch TV, or eat while having phototherapy. But parents should stick to a therapeutic schedule – and never overdo it.
Phototherapy doesn’t cure SAD, depression or other conditions, but it often eases symptoms, increases energy levels, and helps the child feel better about himself/herself – and life. Phototherapy can start to improve symptoms within just a few days. In some cases, though, it can take two or more weeks.
Phototherapy isn't effective for every child on the autism spectrum, but parents can take steps to get the most out of it and help make it a success by using the following guidelines:
1. Stick to a daily routine of therapy sessions to help ensure that your child maintains improvements over time. If your child simply can't do it every day, let him or her take a day or two off, but monitor mood and other symptoms, because you may have to find a way to fit in phototherapy every day.
2. Do some research and talk to your physician before buying a light box. You want to be sure that the light box is safe, the right brightness, and that the style and features make it convenient to use.
3. Stay the course. If you interrupt phototherapy during the winter months, or stop too soon in the spring when you think your child’s symptoms are improving, the symptoms could return.
4. If your child’s symptoms don't improve enough with phototherapy, he or she may need additional treatment. Talk to your physician about other treatment options (e.g., psychotherapy, antidepressants, supplementation, etc.).
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