Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: a chart review study.
One in five autism clinic kids still has severe aggression, self-injury, or tantrums after three medicines—so BCBAs should step in fast with intensive behavior plans.
01Research in Context
What this study did
Doctors looked at 250 clinic charts of kids with autism. They wanted to know how many still had bad aggression, self-hitting, or meltdowns after trying several medicines. They counted a case as "drug-refractory" if three or more meds had failed.
What they found
Fifty-three kids, about one in five, met the tough definition. These kids were older, had classic autism (not just PDD-NOS), and most also had intellectual disability. Medicines alone were not enough for them.
How this fits with other research
Cox et al. (2022) later showed that changing behavior plans cut problem behavior more than changing pills. This supports Boudreau et al. (2015): when meds stall, behavior help is the next step.
SLibero et al. (2016) reviewed earlier papers and already said FBA, reinforcement, and FCT are the go-to ABA tools for autism aggression. The 2015 chart count gives those tools a bigger spotlight.
Hudson et al. (2012) found only a few autism meds have strong RCT proof. Pair that with Boudreau et al. (2015) and you see why so many families still need solid behavior plans after the prescription pad runs dry.
Why it matters
If you serve kids with autism, expect every fifth referral to arrive after three failed med trials. Don’t wait for a fourth pill. Start a full FBA, add differential reinforcement, and teach a communicative replacement the first week.
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02At a glance
03Original 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.
Autism : the international journal of research and practice, 2015 · doi:10.1177/1362361314524641