Medication for Treating Aggression in Asperger's Children

“Are there any medications that can be used to treat aggression in a child with Asperger syndrome? Is it ever advisable to use medication for this purpose?”

Aggression is seldom an isolated problem and is particularly complex in kids with Asperger’s (AS) and High-Functioning Autism (HFA). Aggressive behavior is not always associated with just one condition and can have highly varied sources.

Many studies have been proposed to understand aggressive behavior in young people with AS and HFA. There are promising biologic models that suggest the behavior arises from alterations in dopaminergic reward mechanisms, and cognitive models suggesting that such acts are an outcome of conditioned learning.

Tantrums and aggression are often responses to an array of circumstances and occur in the context of varied emotions. Circumstances preceding and following aggressive outbursts should be observed and documented before selecting a particular medication (e.g., when aggression is a response to anxiety or frustration, the most helpful interventions target those symptoms and the circumstances that produce them, rather than exclusively focusing on the aggressive behavior itself).

Unfortunately, the request for medication typically follows a crisis. The press for a rapid, effective end to the unwanted behaviors may not permit the gathering of much needed data or discussion. Nonetheless, it is not appropriate to “always” begin with one medication or another. Moving to a more “surefire” medication too quickly may mean that the AS or HFA child takes on cardiovascular, endocrinologic, and cognitive risks that may be otherwise avoided.

There are studies in support of using serotonin reuptake inhibitors, alpha-adrenergic agonists, beta-blocking agents, mood stabilizers, and neuroleptics for aggressive behavior. When the doctor has the (a) luxury of time, (b) support of the child’s parents, and (c) collaboration with school staff where the child is attending school, then a medication that is safer, but perhaps takes a longer time to work (or is a little less likely to help) can be tried.

As a side note, it does appear that medications with a greater likelihood of success pose greater risks (e.g., evidence supports use of dopamine blocking agents for aggressive behavior; however, the side effects and long-term risks from these medications are greater than others listed earlier).

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