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Behavioral Issues

Disclaimer: This summary is based on research conducted by Autism Treatment Network (ATN) members. It is not a summary of the entire body of research literature available on this subject

Many kids and teenagers with autism have behavior problems which can be hard on both the child and the family and caregivers [1] [2]. More than half of kids and teens with autism may be physically aggressive (hitting, kicking, biting, etc.) towards caregivers or other kids and grown-ups [1]. Other behavior problems of kids and teens with autism can include being hyperactive, anxious and worried, or hurting themselves by banging or hitting their heads, or biting their hands and fingers [3]. Behavior problems, like hurting other people or themselves, happen more often if the child or teen has trouble sleeping, especially if they wake up in the middle of the night [2][3][4]. Younger kids are more likely to hurt other people, but older kids and teens are more likely to hurt themselves, especially if they have trouble talking [1][3]. Talking, social skills (making friends), and daily living skills (getting dressed, brushing teeth, making food, etc.) have all been shown to be better in children and teens who are good sleepers [5] so talking about sleep problems with a health care provider is important. Medications like Risperidone and Aripiprazole are good at helping kids and teens be less irritable (getting easily upset) and aggressive. Some other drugs may also help with behavior problems and have fewer side effects [6]. Medications that help with behavior problems often make kids and teens gain weight. To help kids and teens stay at a healthy weight, health care providers can think about using a second medicine called Metformin when they give medications for aggression [7]. Many moms and dads of children with autism with big behavior problems have a hard time feeling good about being a parent and struggle to have friends. Treatments that help with behavior problems such as Applied Behavioral Analysis (ABA), counseling, and medications may help the whole family feel better [2].

Frequently Asked Questions

  1. WHAT HAPPENS TO THE CHILD/TEENAGER?

    • Many can be physically aggressive – hitting, kicking, biting, etc.
    • Others can be hyperactive, anxious, worried, or hurt themselves [3].
  2. WHEN DO WE SEE THIS HAPPENING? Behavior problems happen more often:

    • If the child or teen has trouble sleeping or communicating [1][2][3][4]
    • Younger kids are more likely to hurt others
    • Older kids and teens are more likely to hurt themselves, especially if they have weak language skills [1][3]
  3. WHAT CAN HEALTH CARE PROVIDERS OFFER? Medications that can help children or teenagers with behavioral issues:

    • Risperidone
    • Aripiprazole
  4. WHAT SIDE EFFECTS ARE THERE?

    • Risperidone and Aripiprazole are good at making kids and teens less irritable (less tantrums and meltdowns) and aggressive.
    • Other drugs may also help with behavior problems and have fewer side effects [6].
    • Medications that help kids and teens with behavior problems often make them gain weight
    • Metformin can help kids and teens stay at a healthy weight [7].
  5. WHAT SHOULD PARENTS DO?

    • Talk with your health care provider or therapist to learn about behavior issues.
    • If you are not sure, ask them what to look for. What information do they need from you to help your child/teen with their behavior problems?
    • Talk with your health care provider to learn about what medications can help with behavior issues and what side effects are common.

Additional Tips

Take your findings to your next appointment. All children and teens with ASD should be checked for behavior problems. Health care providers may prescribe medications to help children and teens with autism feel less irritable and be less aggressive [6]. Treatments that help with behavior problems may help the whole family feel better [2].


References

  1. Kanne SM, Mazurek MO. Aggression in children and adolescents with ASD: prevalence and risk factors. Journal of Autism and Developmental Disorders. 2011 ;41:926-937. JID: 7904301; ppublish
  2. Sikora DM, Moran E, Orlich F, Hall TA, Kovacs EA, Delahaye J, et al.. The relationship between family functioning and behavior problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders. 2013 ;7:307-315.
  3. Soke GN, Rosenberg SA, Hamman RF, Fingerlin T, Rosenberg CR, Carpenter L, et al.. Factors associated with self-injurious behaviors in children with autism spectrum disorder: findings from two large national samples. Journal of Autism and Developmental Disorders. 2017 ;47:285–296.
  4. Mazurek MO, Sohl KA. Sleep and behavioral problems in children with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2016 ;46:1906–1915.
  5. Sikora DM, Johnson KP, Clemons TE, Katz TF. The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders. Pediatrics. 2012 ;130:S83-90. NLM Journal Code: oxv, 0376422
  6. Fung LK, Mahajan R, Nozzolillo AA, Bernal MPilar, Krasner A, Jo B, et al.. Pharmacologic treatment of severe irritability and problem behaviors in autism: a systematic review and meta-analysis. Pediatrics. 2016 ;137:S124–S135.
  7. Anagnostou E, Aman MG, Handen BL, Sanders KB, Shui AM, Hollway JA, et al.. Metformin for treatment of overweight induced by atypical antipsychotic medication in young people with autism spectrum disorder: a randomized clinical trial. JAMA Psychiatry. 2016 ;73:928–937.