58.4 PSYCHOPHARMACOLOGY REVIEW AND SAFETY PLANNING FOR AUTISM SPECTRUM DISORDER YOUTH WITH IMPULSIVE AGGRESSION

Abstract

Children and adolescents with autism spectrum disorder (ASD) are often referred for mood dysregulation, aggression, and other maladaptive behaviors. Safety concerns create urgency for safe and effective pharmacotherapy and behavioral interventions. When comorbid conditions (eg, intellectual disability, mood disorders, psychosis, and ADHD) are present, pharmacological interventions are often complex and complicated by parental fears, medication interactions, and side effects. Participants will: 1) review research on pharmacological interventions that may reduce frequency and intensity of acute agitation, self-injurious behaviors, irritability, and impulsive aggression in youth with ASD; 2) learn strategies to manage safety during outpatient visits with youth with ASD; and 3) learn prescribing options when treating patients with ASD and co-occurring conditions that may be complicating the presentation. Therapeutic strategies to target maladaptive behaviors will be presented. Evidence from a PubMed review of literature to manage irritability and impulsive aggression in ASD will be reviewed. Strong evidence supports the use of atypical antipsychotics for severe irritability and aggression in ASD. However, there are limited randomized, placebo-controlled trials in other areas of impairment for ASD. Evidence for pharmacological interventions used to treat comorbid conditions (anxiety, bipolar disorder, mood instability, and ADHD) in this population will be presented. Limited evidence for novel agents (N-acetylcysteine, D-cycloserine, arbaclofen, cannabidiol oil, and naltrexone) will also be reviewed. Attendees will review recent literature on pharmacologic interventions to address mood dysregulation and impulsive aggression in youth with ASD. They will learn to develop a rational treatment plan based on treating the most serious presenting symptoms. As rates of ASD diagnosis continue to increase, it is essential for clinicians to be aware of current research to provide appropriate pharmacologic interventions. Caregiver stress for youth with ASD can be diminished when there is decreased frequency and intensity of aggression, mood dysregulation, and other maladaptive behaviors.