Why Consider Matthew’s Protocol in Autism Care?

Many autistic children experience co-occurring mood dysregulation, irritability, aggression, or emotional outbursts. These behaviors can overshadow progress in communication, learning, and connection. At Onward Growth Psychiatry, we offer a thoughtful, clinically driven adaptation of Matthew’s Protocol for those children whose primary challenges include emotional and behavioral reactivity rather than only social-communication symptoms.

Matthew’s Protocol was pioneered by Dr. Daniel Matthews, primarily in children with Disruptive Mood Dysregulation Disorder (DMDD) and severe emotional lability. The protocol is built on the idea that in susceptible brains, certain electrical/limbic-region dysregulation amplifies mood instability and outbursts. By restoring stability in these circuits using carefully chosen medications, the child may become better able to tolerate frustration, regulate emotion, and engage more positively in therapy, learning, and communication. The Matthews protocol utilizes amantadine (Symmetrel) and oxcarbazepine (Trileptal), two medications that generally carry a lesser burden of side effects compared to other neuroleptic mood stabilizers frequently employed in managing DMDD.

In autism, the benefits may include:

Reduced frequency and severity of emotional outbursts
Increased tolerance of demand and transitions
Less interference from behavioral dysregulation so that therapies (speech, OT, ABA, etc.) can “get through”
Secondary improvement in mood, attention, and responsiveness

How Matthew’s Protocol Works

Matthew’s Protocol involves a multi-phase strategy using anti-epileptic / stabilizing agents and amantadine to help regulate excitability in brain circuits (particularly in limbic, emotional, and regulatory zones) rather than suppressing behavior with high-dose antipsychotics. The Matthews Protocol involves a phased introduction of medications, beginning with Amantadine and followed by Trileptal (oxcarbazepine). This method helps in pinpointing any side effects and understanding their causes more effectively.

Common side effects include dizziness, insomnia, and nausea. It is important to monitor these effects closely to adjust the treatment as necessary. Please read our blog here to learn more.

Starting with Amantadine:

For children under 100 lbs, treatment begins with a dose of 25 to 50 mg each morning, which is increased by 25 mg every 5-7 days.

Key principles include:

Start low, move slowly — care with dosing, vigilant monitoring
Target the neuroelectric baseline rather than simply “addressing aggression”
Supportive therapies run in parallel — behavior, speech, environment modifications
Frequent reassessments to determine whether medication can be tapered or withdrawn over time as self-regulation improves
Clients who do not tolerate amantadine may be trialed on memantine instead

Introducing Oxcarbazepine/Trileptal:

Trileptal, also known as oxcarbazepine, is an anti-seizure medication that can help both bipolar disorder and disruptive mood dysregulation disorder.
Some potential side effects include dizziness, fatigue, and a risky rash that requires particular attention, especially in individuals of Asian descent.
Clients who do not tolerate Trileptal may be trialed on lamotrigine as an alternative

Who Is a Candidate?

Matthew’s Protocol may be considered in children who:

Have autism with frequent, severe emotional outbursts, irritability, or aggression
Have been diagnosed with Disruptive Mood Dysregulation Disorder (DMDD)
Have minimal response to behavioral or conventional psychopharmacologic interventions
Show EEG anomalies or neurophysiologic indicators of excitability (if available)
Are medically stable (i.e. no contraindications)
Families are ready for close monitoring, labs, and commitment to integrated care

We do not apply Matthew’s Protocol as a first-line for core autism features such as social communication or restrictive/repetitive behaviors. Instead, it’s an option when behavioral and temper dysregulation present a barrier to progress.

Our Approach at Onward Growth Psychiatry

At Onward Growth Psychiatry, we integrate Matthew’s Protocol into broader, neurodevelopmental care:

Comprehensive Baseline Assessment: development, behavior history, labs, EEG/neurophysiology (if available)
Individualized Protocol Planning: selecting which medications and dose schedule
Close Monitoring & Adjustment
Parallel Therapeutic Supports: parent support, behavioral strategies, speech and OT support
Tapering Strategy: as self-regulation improves, we assess reduction of medications

Because we are a private-pay, integrative psychiatric practice, we can spend the time needed to adjust and monitor safely.

Take the Next Step

If your child’s emotional dysregulation, aggression, or mood instability is hindering progress, Matthew’s Protocol might be a valuable addition. We offer a free consultation to evaluate whether your child is a good fit, discuss risks/benefits, and plan a possible trial in the context of integrative care.

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