Craig A. Erickson, M.D., Naomi B. Swiezy, Ph.D., Kimberly A. Stigler, M.D., Christopher J. McDougle, M.D., and David J. Posey, M.D.
While psychostimulant treatment has been associated with reductions in aggression in children with attention-deficit/hyperactivity disorder, results in autism have been equivocal. Posey et al. (2004a) reported on a randomized, placebo-controlled, crossover study of methylphenidate (Ritalin, Concerta, Metadate) in children with PDD. Methylphenidate treatment was associated with small-to-medium improvements in hyperactivity but caused irritability in some patients. There was no improvement in aggression.
Conclusion
A comprehensive treatment plan for treating aggressive behaviors in children with autism begins with a precise and thorough assessment, followed by implementation of a comprehensive treatment plan. This treatment plan must incorporate ongoing behavioral assessment and intervention with continuous evaluation for areas in which pharmacotherapy could potentially curtail maladaptive and dangerous behaviors.
From a pharmacotherapy perspective, atypical antipsychotics, particularly risperidone, have shown the most promise in reducing aggressive behavior. Future directions in treating aggression in children with autism include further investigation of atypical antipsychotics that may not cause significant weight gain and testing the efficacy of manualized behavioral treatments.
Dr. Erickson is a resident in psychiatry at the Indiana University School of Medicine and the Christian Sarkine Autism Treatment Center (CSATC).
Dr. Swiezy is clinical associate professor of psychology and psychiatry at the Indiana University School of Medicine and clinical director of CSATC.
Dr. Stigler is assistant professor of psychiatry at the Indiana University School of Medicine.
Dr. McDougle is the Albert E. Sterne Professor and chairperson of the department of psychiatry at the Indiana University School of Medicine.
