Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis
Abstract
BACKGROUND: Autism spectrum disorder (ASD) is increasingly recognized as a public health issue. Irritability and aggression (IA) often negatively affect the lives of people with ASD and their families. Although many medications have been tested for IA in ASDs in randomized controlled trials (RCTs), critical quantitative analyses of these trials are lacking in the literature. OBJECTIVES: To systematically review and quantitatively analyze the efficacy and safety of pharmacologic treatments for IA in youth with ASD. DATA SOURCES: Studies were identified from Medline, PsycINFO, Embase, and review articles. METHODS: Original articles on placebo-controlled RCTs of pharmacologic treatments of IA in youth age 2 to 17 years with ASD were included. Data items included study design, study goals, details of study participants, details of intervention, study results, statistical methods, side effects, and risks of bias. The primary study outcome measure was the effect size of reduction in the Aberrant Behavioral Checklist–Irritability (ABC-I) scores in the medication group, as compared with placebo, in RCTs using parallel groups design. RESULTS: Forty-six RCTs were identified. Compared with placebo, 3 compounds resulted in significant improvement in ABC-I at the end of treatment. Risperidone and aripiprazole were found to be the most effective, with the largest effect sizes. Sedation, extrapyramidal sides effects, and weight gain were assessed quantitatively. CONCLUSIONS: Although risperidone and aripiprazole have the strongest evidence in reducing ABC-I in youth with ASD, a few other compounds also showed significant efficacy with fewer potential side effects and adverse reactions in single studies.
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One meta-analysis on pharmacological treatment of irritability and problem behaviors in ASD did report that the number of subjects needed to treat was lower for risperidone.
“one meta-analysis on pharmacological treatment of irritability and problem behaviors in ASD did report that the number of subjects needed to treat was lower for risperidone [138].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [138]
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Self-citation
- Authors
- Fung, L. K., Mahajan, R., Nozzolillo, A., Bernal, P., Krasner, A., Jo, B., Coury, D., Whitaker, A., Veenstra-Vanderweele, J., & Hardan, A. Y.
- Affiliations
- Stanford University (US)
- Kennedy Krieger Institute (US)
- Massachusetts General Hospital (US)
- Kaiser Permanente Northern California (US)
- NewYork–Presbyterian Hospital (US)
- The Ohio State University (US)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2016-02-01
- Volume
- 137
- Issue
- Supplement_2
- Pages
- S124-S135
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2280843891
- Cited by
- 294
- References
- 63
- Citations by year
- 2026: 18 · 2025: 25 · 2024: 27 · 2023: 34 · 2022: 34 · 2021: 49 · 2020: 44 · 2019: 24 · 2018: 21 · 2017: 11 · 2016: 7
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- autism spectrum disorder, irritability, aggression, behavioral problems, pharmacotherapy, risperidone, aripiprazole, adverse drug reactions, sedation, extrapyramidal symptoms, weight gain, youth
- MeSH terms
- Problem Behavior, Autism Spectrum Disorder, Aripiprazole, Adolescent, Child, Child Development Disorders, Pervasive, Child, Preschool, Humans, Irritable Mood, Antipsychotic Agents, Self-Injurious Behavior, Risperidone
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