From the Guidelines
Treatment for aggression in children with autism should prioritize a comprehensive approach, combining behavioral interventions, environmental modifications, communication training, and, when necessary, pharmacotherapy, with risperidone being a considered option for severe cases, as evidenced by preliminary evidence from the Journal of the American Academy of Child and Adolescent Psychiatry 1. When managing aggression in children with autism, it's crucial to individualize the treatment plan, focusing initially on non-pharmacological strategies. This includes:
- Behavioral interventions like Applied Behavior Analysis (ABA) to identify and address triggers of aggression
- Environmental modifications to reduce sensory overload
- Establishing consistent routines to provide a sense of security and predictability
- Communication training, such as Picture Exchange Communication System (PECS) or speech therapy, to reduce frustration that may lead to aggressive behaviors For cases where these interventions are not sufficient, or when aggression is severe, pharmacologic interventions may be considered. Risperidone is noted in the literature as a potential option for managing irritability, including physical aggression, in children with autism spectrum disorder (ASD) 1. However, any pharmacotherapy should be carefully monitored due to potential side effects, and the goal should always be to facilitate the child's adjustment and engagement with educational interventions. Combining medication with parent training is found to be more efficacious than medication alone for decreasing serious behavioral disturbances and improving adaptive functioning 1. Regular reassessment and adjustment of the treatment plan as the child develops are essential for optimal outcomes.
From the FDA Drug Label
RISPERIDONE is indicated for the treatment of irritability associated with autistic disorder, including symptoms of aggression towards others, deliberate self-injuriousness, temper tantrums, and quickly changing moods Efficacy was established in 3 short-term trials in children and adolescents (ages 5 to 17 years)
Autism Aggression Treatment in Children: Risperidone is indicated for the treatment of irritability associated with autistic disorder, including symptoms of aggression towards others. The efficacy of risperidone in treating autism aggression in children was established in 3 short-term trials in children and adolescents (ages 5 to 17 years) 2.
- Key Points:
- Risperidone is approved for the treatment of irritability associated with autistic disorder in children.
- Efficacy was established in short-term trials in children and adolescents (ages 5 to 17 years).
- Risperidone may help reduce symptoms of aggression towards others in children with autistic disorder.
From the Research
Autism Aggression Treatment in Children
- Autism spectrum disorder (ASD) is often comorbid with behavioral disturbances such as irritability, aggression, and hyperactivity 3.
- Aggression is one of the most frequent and debilitating problems observed among persons with ASD, and treating the behavior is a high priority 4.
- Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities 5.
Treatment Options
- Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD 5.
- Pharmacologic treatments, particularly the use of second-generation antipsychotics, such as risperidone and aripiprazole, may also be of some benefit in reducing aggression in individuals with ASD 6, 5, 3.
- Risperidone and aripiprazole are approved by the USA Food and Drug Administration for the treatment of irritability and aggression in children from the ages of 5 and 6 years, respectively 6.
Effectiveness of Treatment
- A retrospective case study found that risperidone or aripiprazole combined with standard supportive therapies improved ASD core signs and symptoms in young children (<4 years) with persistent irritability and aggression 6.
- The study observed minimal-to-no symptoms in 60% of patients according to the Childhood Autism Rating Scale 2-Standard Test and Clinical Global Impression scales 6.
- However, excessive weight gain was observed in two patients, highlighting the need for careful monitoring of adverse effects 6.