What is the best treatment for a 14-year-old male with Autism Spectrum Disorder (ASD) and anger issues?

From the Guidelines

The best treatment for a 14-year-old male with Autism Spectrum Disorder (ASD) and anger issues typically involves a comprehensive approach combining behavioral therapy, family support, and possibly medication, with a focus on addressing the underlying causes of anger. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of a multimodal treatment plan [ 1 ].

Key Components of Treatment

• Behavioral Therapy: Applied Behavior Analysis (ABA) therapy and Cognitive Behavioral Therapy (CBT) adapted for teens with ASD are essential components of treatment, helping the adolescent understand triggers for anger and develop coping strategies [ 1 ].
• Family Support: Parent training programs are crucial to ensure consistent responses to behaviors across environments, which can help reduce anger outbursts [ 1 ].
• Medication: If behavioral interventions alone are insufficient, a child psychiatrist might consider risperidone (starting at 0.25-0.5mg daily, gradually increasing if needed) or aripiprazole (starting at 2mg daily), which are FDA-approved for irritability in ASD [ 1 ].
• Social Skills Groups: Social skills groups specifically designed for teens with ASD can address social communication difficulties that often underlie frustration [ 1 ].
• Sensory Integration Therapy: This may help if sensory sensitivities contribute to anger outbursts [ 1 ].

Monitoring and Side Effects

Medications such as risperidone should be monitored closely for side effects including weight gain and metabolic changes [ 1 ]. The most effective approach addresses the underlying causes of anger rather than just the symptoms, recognizing that anger in ASD often stems from communication difficulties, sensory overload, or difficulty with changes in routine.

Prioritizing Non-Pharmacological Interventions

Given the potential side effects of medication, non-pharmacological means of addressing irritability and aggression should be thoroughly assessed and implemented before considering medication [ 1 ]. This comprehensive approach prioritizes the well-being and quality of life of the individual with ASD, aiming to minimize morbidity and mortality associated with untreated anger issues.

From the FDA Drug Label

The efficacy of RISPERIDONE in the treatment of irritability associated with autistic disorder was established in two 8-week, placebo-controlled trials in children and adolescents (aged 5 to 16 years) who met the DSM-IV criteria for autistic disorder. Efficacy was evaluated using two assessment scales: the Aberrant Behavior Checklist (ABC) and the Clinical Global Impression - Change (CGI-C) scale. The primary outcome measure in both trials was the change from baseline to endpoint in the Irritability subscale of the ABC (ABC-I) RISPERIDONE, starting at 0.25 mg/day or 0.5 mg/day depending on baseline weight (< 20 kg and ≥ 20 kg, respectively) and titrated to clinical response (mean modal dose of 1.9 mg/day, equivalent to 0.06 mg/kg/day), significantly improved scores on the ABC-I subscale and on the CGI-C scale compared with placebo.

The best treatment for a 14-year-old male with Autism Spectrum Disorder (ASD) and anger issues is Risperidone. The recommended dose is 0.5-3.5 mg/day on a weight-adjusted basis, starting at 0.25 mg/day or 0.5 mg/day depending on baseline weight, and titrated to clinical response.

• Key benefits: Significant improvement in irritability symptoms, including aggression, self-injuriousness, and temper tantrums.
• Important considerations: Weight gain and somnolence are common adverse reactions in pediatric patients. 2

From the Research

Treatment Options for Autism Spectrum Disorder (ASD) and Anger Issues

The treatment for a 14-year-old male with Autism Spectrum Disorder (ASD) and anger issues can involve various approaches, including medication and behavioral interventions.

• Medication:
  • Selective serotonin reuptake inhibitors (SSRIs) have been studied for their effectiveness in treating conditions comorbid with ASD, such as depression, anxiety, and obsessive-compulsive behaviors 3.
  • However, the evidence for the use of SSRIs in children with ASD is limited, and there is emerging evidence of harm 3.
  • Antipsychotic medications, such as risperidone, have been shown to be effective in reducing irritability and behavioral problems in ASD, but should be considered a last resort due to potential side effects 4.
• Behavioral Interventions:
  • Intensive behavioral intervention (IBI) has been shown to be effective in reducing aggression in youths with ASD, and the combination of IBI with antipsychotic medication may be the most effective approach 5.
  • Attention-based cognitive behavioral treatment, based on mindfulness cognitive therapy (MBCT) and dialectical behavior therapy (DBT), has been shown to reduce aggressive behavior and improve anger coping in school-aged autistic children 6.
• Other Considerations:
  • SSRI monotherapy may be effective for anxiety disorders in children and adolescents with ASD, even if prior SSRI trials have been unsuccessful 7.
  • It is essential to consider the individual's specific needs and circumstances when selecting a treatment approach, and to weigh the potential benefits and risks of each option.