Pharmacological Approach to Treating Aggressive and Self-Injurious Behaviors in Autistic Individuals

The pharmacological approach continues to be one of the important components of a comprehensive treatment for severe aggressive behaviors and self-injurious behaviors (SIB) in autistic individuals. One of the most captivating aspects of these severe problematic behaviors is their uncertain etiology. Severe aggressive behaviors and self-injury behaviors (SIB) can result in significant harm to individuals with autism and distress for their caregivers and families.

Parikh, Koleyzon and Hollander (2008), from the Mount Sinai School of Medicine, NY, reviewed twenty one trials with 12 psychotropic medications selected from randomized placebo-controlled trials studies and only five psychotropic medications produced significant improvement when compared to placebo [Tianeptine, Methylphenidate, Risperidone, Clonidine, and Naltrexone.] Of these five medications, only Risperidone and Methylphenidate demonstrated results that have been replicated across at least two studies.

While no single drug or class of medication has yet emerged as consistently effective for the treatment of severe aggressive and self-injurious behaviors in autistic individuals, however, Ratey et. al. (1987) showed that Beta-blockers have a remarkable effect in diminishing the occurrence of severe aggressive and self-injury behaviors. In an "open label" study that evaluated several drugs used to treat self-injurious behaviors, Clonazepam, Propranolol, Sertraline and Clomipramine showed observable control of the problematic behaviors (Luiselli, et. al. 2000).

In the Central Institute of Mental Health, Child and Adolescent Psychiatry, Germany, Rothenberger (1993), reported that by using Sulpiride (Benzamide derivative) self-injurious behaviors was significantly reduced in several individuals with autism. (Sulpiride is a selective dopamine D2 antagonist with antipsychotic and antidepressant activity).

I think while several studies indicate that Risperidone, Methylphenidate, and a combination of a beta-blockers (Propranolol) or alpha-blockers (Clonidine) and a Selective Serotonin Reuptake Inhibitor (SSRI) (Sertraline or Clomipramine) may be effective in reducing severe aggressive behaviors and self-injurious behaviors, however, additional placebo-controlled trials are needed on other potential drugs to increase the number of therapeutic options available in the treatment of severe problematic behaviors in individuals with autism.