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Autism

Handlng Autistic Agression

05/02/2006

Question:

My 12 year old Autistic child of course has always been difficult but lately he has been uncontrollable. He was on 3 pills of resperidal 3 times a day and he was geting more aggressive. The doctor has since then switched his medicines to serequal and divoprex. He keeps punching us and pinching himself to the point of bruising everywhere. He will hurt himself,get mad and come over and hit someone, alot of the times it is me. My husband says we must put him in his room every time he does this and lock the door till he settles down. This makes him very mad and he is destroying his room, holes in the walls etc. He even smashed through my dining room window last week. When he comes out after calming down he decides he must hit me again and the cycle repeats all day. Any advice would be appreciated he is even throwing things across the dinner table. I know he gets mad because he hurts himself but he can`t stop.

Answer:

The situation you describe sounds rather urgent, with poor response to common medications that usually stop self-injury and aggression in children with autism. If there has not been a recent re-evaluation of the diagnosis, that would be a good idea, considering, among other things, the possibility of atypical seizure disorder (autism carries an increased risk of seizures), mood disorder, and Tourette's disorder, as well as some kind of over-sensitivity or under-sensitivity to one or more of the medicines.

You do not mention what behavioral treatment your son may be getting or what coaching you have had in managing behavior at home, but such treatment is often useful. In fact, we are currently doing a study comparing medication alone to the combination of medication and parent training in behavior management. If you have not had behavioral treatment or coaching, contact whatever local resource you have (county MR/DD board, university, etc.) If you are in Central Ohio, Children's Hospital has an autism center that could help you with that (614-355-8315), and if you live in Franklin Co., you could get into the county-sponsored behavioral services program (for behavioral treatment) at Nisonger Center and/or the Nisonger Dual diagnosis Clinic (for medication consultation) by calling 614-464-2743 and asking for intake.

One behavioral treatment that is somewhat controversial but very effective as a last resort for self-injury is the SIBIS, which was developed by Dr. Tom Linscheid, a behavioral psychologist at Columbus Children's Hospital. It is controversial because it uses aversive conditioning, an uncomfortable electric shock, whenever the patient hits himself. It is especially useful for head-hitting because it can be set up with a helmet that automatically triggers a shock when the helmet is jarred. In my view, when other interventions fail, this is justified because repeated head hitting can result in detached retinas and blindness, not to mention other injuries. Other kinds of self-injury can also be managed. If you have reached the point of desperation where you wish to consider this, contact the Columbus Children's Hospital Psychological Services for a consultation by calling (614) 722-4700 or the Columbus Children's Hospital Developmental Assessment Program at (614) 355-8315.

If the serious situation you describe continues and it becomes obvious that there is imminent danger to your son or others (including yourself), you will have to consider residential treatment with closer supervision or even hospitalization. If it becomes necessary to call the police to prevent bodily harm, I suggest having them take him to the nearest emergency mental health facility or hospital emergency room for possible admission to a psychiatric hospital.

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Response by:

L Eugene Arnold, MD, MEd L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University