The neurobiology of aggression: implications for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities.
Drugs rarely curb aggression in ID—risperidone is the lone exception, so pair behavior plans and exercise first.
01Research in Context
What this study did
Willner (2015) read every drug trial he could find on adults and kids with intellectual disability who hit, bit, or kicked.
He looked at pills for mood, seizures, and psychosis. He asked: do these drugs really lower aggression?
The review covered antidepressants, antipsychotics, and anticonvulsants, but only risperidone showed any clear benefit.
What they found
Only risperidone cut aggression better than sugar pills.
Other drugs failed again and again.
Side effects were common, and benefits were small or missing.
How this fits with other research
In-Lee et al. (2012) found exercise beats drugs. Four workouts a week, 31-60 minutes each, gave a medium-size drop in behavior problems.
Modi et al. (2015) showed that heavy pill loads, not IQ level, send adults to crisis units. Aggression plus many meds predict hospital admission.
Hsieh et al. (2014) remind us that aggression serves many functions across ID levels, so drugs can’t fix what behavior plans can teach.
Why it matters
Before you add another med, try an ABA plan and add exercise. Track data for two weeks. If aggression stays high, then consider risperidone as the only med with solid proof.
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02At a glance
03Original abstract
AIM: The aim of this review is to summarise current understanding of the neurobiology of aggression and within this context to consider the evidence base for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities (ID). EVIDENCE: Aggressive encounters involve a variety of psychological processes and progress has been made in understanding the brain mechanisms involved. However, the role in aggression of the neurotransmitters serotonin, dopamine and γ-aminobutyric acid is no longer as clear as it once appeared, with the result that predictions cannot be made with confidence about drug effects on aggression. There have been relatively few controlled trials of pharmacotherapy for aggression in people with ID, or, indeed, in the general population, and their outcomes have largely been negative. CONCLUSION: With the possible exception of risperidone, there is no reliable evidence that antidepressant, neuroleptic or anticonvulsant drugs are effective treatments for aggression by people with ID.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12120