Treatment of Aggression in Adults with Autism Spectrum Disorder: A Review

Abstract

Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by markedly impaired social interaction, impaired communication, and restricted/repetitive patterns of behavior, interests, and activities. In addition to challenges caused by core symptoms, maladaptive behaviors such as aggression can be associated with ASD and can further disrupt functioning and quality of life. For adults with ASD, these behaviors can portend adverse outcomes (e.g., harm to others or to the individual with ASD, hindering of employment opportunities, criminal justice system involvement). This article reviews the scientific literature to provide an update on evidence-based interventions for aggression in adults with ASD. Method A search of the electronic databases CINAHL, EMBASE, and PsycINFO was conducted using relevant search terms. After reviewing titles, abstracts, full-length articles, and reference lists, 70 articles were identified and reviewed. Results The strongest (controlled trial) evidence suggests beneficial effects of risperidone, propranolol, fluvoxamine, vigorous aerobic exercise, and dextromethorphan/quinidine for treating aggression in adults with ASD, with lower levels of evidence supporting behavioral interventions, multisensory environments, yokukansan, and other treatments. Conclusions Additional randomized, controlled trials using consistent methodology that adequately addresses sources of bias are needed to determine which treatments are reliably effective in addressing aggression in adults with ASD. In the meantime, considering efficacy and adverse effect/long-term risk profiles, a practical approach could start with functional assessment–informed behavioral interventions along with encouragement of regular, vigorous aerobic exercise to target aggression in adults with ASD, with pharmacotherapy employed if these interventions are unavailable or inadequate based on symptom acuity.

Self‐management interventions for reducing challenging behaviors among school‐age students: A systematic review

“…Descriptive information is determined based on a review of each domain receiving a code of “low,” “high,” or “unclear” risk of bias. The SCD RoB tool has recently been applied to meta‐analyses including SCD studies across the fields of education (e.g., Martinez et al, 2021), psychology (Davis et al, 2019), and psychiatry (e.g., Im, 2021). Results for our risk of bias assessment for SCD studies are presented in Figure 2.…”

Clinical Safety and Treatment of Severe Aggression: Behavioral-Pharmacological Intervention Evaluation in a Young Adult With Autism Spectrum Disorder

“…Aggression in persons with IDD and ASD may be learned behavior, have a medical etiology, or stem from a psychiatric disorder (Antonacci et al, 2008; Im, 2021). Theories of causation are the foundation of treatment methodology which in the case of aggression is dominated by behavioral, pharmacological, and combined behavioral-pharmacological interventions (Matson & Dempsey, 2008; Poling et al, 2017).…”

“…From an extensive review of the research literature on treating aggression in adults with ASD, Im (2021) concluded that clinicians should begin with functional assessment followed by assessment-informed behavioral interventions and environmental modifications as necessary. If treatment is not successful, “or if the acuity of the individual’s aggression is too high to permit safe and effective implementation of these approaches” (p. 74), pharmacotherapy should be initiated at the lowest dose possible to produce therapeutic and avoid adverse effects.…”

Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews

“…Aripiprazole and risperidone are the only two drugs approved by the United States Food and Drug Administration5 6 for children with ASD, specifically to treat irritability. However, their limited efficacy, rates of adverse events and lack of benefits for core symptoms of ASD7 8 raise non-pharmacological interventions as a promising alternative with a broader potential.…”