title: Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: a chart review study.
abstract: Aggression, self-injurious behavior, and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders. Despite US Food and Drug Administration approval of two atypical antipsychotics targeting these symptoms in youth with autistic disorder, they remain frequently drug refractory. We define drug-refractory aggression, self-injurious behavior, and severe tantrums in people with autism spectrum disorders as behavioral symptoms requiring medication adjustment despite previous trials of risperidone and aripiprazole or previous trials of three psychotropic drugs targeting the symptom cluster, one of which was risperidone or aripiprazole. We reviewed the medical records of individuals of all ages referred to our clinic for autism spectrum disorder diagnostic evaluation, as well as pharmacotherapy follow-up notes for all people meeting autism spectrum disorder criteria, for drug-refractory symptoms. Among 250 consecutively referred individuals, 135 met autism spectrum disorder and enrollment criteria, and 53 of these individuals met drug-refractory symptom criteria. Factors associated with drug-refractory symptoms included age 12 years or older (p < 0.0001), diagnosis of autistic disorder (p = 0.0139), and presence of intellectual disability (p = 0.0273). This pilot report underscores the significance of drug-refractory aggression, self-injurious behavior, and severe tantrums; suggests the need for future study clarifying factors related to symptom development; and identifies the need for focused treatment study of this impairing symptom domain.
authors.affiliation: Seattle Children's Hospital, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Adler
authors.affiliation: Cincinnati Children's Hospital Medical Center, USA.
authors.forename: Logan K
authors.initials: LK
authors.lastname: Wink
authors.affiliation: Riley Children's Hospital, USA Indiana University School of Medicine, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Early
authors.affiliation: Riley Children's Hospital, USA Indiana University School of Medicine, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Shaffer
authors.affiliation: Riley Children's Hospital, USA Indiana University School of Medicine, USA.
authors.forename: Noha
authors.initials: N
authors.lastname: Minshawi
authors.affiliation: Lurie Center for Autism, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McDougle
authors.affiliation: Cincinnati Children's Hospital Medical Center, USA Craig.Erickson@cchmc.org.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Erickson
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D001321:Autistic Disorder / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000188:drug therapy / Q000523:psychology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010879:Piperazines / Q000627:therapeutic use*; D015363:Quinolones / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D018967:Risperidone / Q000627:therapeutic use*; D016728:Self-Injurious Behavior / Q000188:drug therapy* / Q000523:psychology; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole; D018967:Risperidone
keywords: aggression; atypical antipsychotics; autism; autism spectrum disorders; self-injurious behavior; severe tantrums