2 May


By Lirio Sobrevinas-Covey, Ph.D.

Irritability and impulsive aggression are significant problems of many persons with autism spectrum disorder (ASD), causing major challenges to the persons themselves and their families. Behavioral interventions are the first line of treatment for these conditions. Also important is to ascertain and, treat as needed, the influence of comorbid medical or psychological conditions, such as unreported pain, stress, depression, or anxiety that may be underlying the dysfunctional emotions and behaviors. When the first line approaches do not provide improvement, pharmacological treatment may be considered.

A review and meta-analysis was conducted to test the efficacy and safety of drug treatments for reducing irritability and aggression in youth (aged 2 to 17 years). Forty-six randomized clinical trials that compared the active drug to placebo were included. The measured outcome was the reduction of the patients’ score from baseline to the end of treatment on a behavior checklist – the Aberrant Behavior Checklist-Irritability (ABC-I).

The strongest evidence of significant improvement was observed for risperidone (Risperdal) and aripiprazole (Abilify). These two medications have received approval by the US Federal Drug Administration for treating irritability and aggression in autistic youth. Two other compounds (valproate and N-acetylcysteine) also showed significant symptom reduction but less strongly than risperidone and aripriprazole.

Both risperidone and aripiprazole when compared with placebo showed higher rates of sedation, somonolence, weight gain, and extrapyramidal symptoms. Thus, patients treated with these medications should be monitored for the emergence of those and other adverse effects. Withdrawal of the drug or dose change could follow.

Considerations of efficacy (does it improve symptoms?) and safety (does it have adverse effects?) are necessary when selecting which drug to use in cases of severe irritability and aggression. Combining the drug treatment with behavioral interventions and programs delivered by therapeutic professionals, family and caregivers, is of further importance. Emotional regulation, experienced in moments or days, bestows much sought-after quality of life for the person with ASD and his/her family.

Reference: Fung LK, Mahajan R, Nozzolillo A et al. A Systematic Review and Meta-analysis. Pediatrics 2016; 137.

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