What pharmacological management do you consider for self-injurious behavior in patients with autism spectrum disorder?  

This is a great question but requires a nuanced answer. It all depends. In short, what I think the clinician needs to know is whether the patient with ASD and self-injury has a treatable condition that is driving self-injury. Perhaps the most critical is whether the patient has a medical problem th...

Great helpful insights from everyone. The only thing I might add from an inpatient perspective, aside from the advantage of being able to do a medical workup in a quicker time frame, is the ability to monitor dietary intake and bowel movements. I would like to emphasize how many parents believe in t...

Superb response by Dr. @Walkup! I would add that ASD treatment should never be on an island and that it is a team-based approach. I never started medication until I had a thorough evaluation from a behavioral analyst. All too often, self-injury gets reinforced. I remember a facility brought a patie...

In psychiatry and medicine in general, we often face the reality that many of our pharmacological interventions don't actually "cure" disorders. Instead, they focus on managing the symptoms associated with these diagnosed conditions. This is particularly true in the treatment of self-injurious behav...

Terrific answers all. I often find that self-injurious (and aggressive) behavior in this population can represent frustration arising from a concurrent communication and/or processing disorder. In the workup of these kids, getting a full audiology and auditory processing evaluation and a more detai...

If you are looking for opinions on what meds (other than antipsychotics) might be helpful, I have found clonidine (especially clonidine patch), guanfacine, and Depakote to be therapeutic in some ASD patients. My experience with naltrexone is that it hasn't been especially helpful but I think it's st...

Thank you all for your thoughts and wisdom.  I find a referral to the behavioral parent training program in my part of the country invaluable (at UCLA) and the kids are on a track.  The amount of consistent behavioral changes (ignoring the behavior, redirect, be consistent) I have witnes...

I am no longer working in child psychiatry, but I found the discussion incredibly helpful had I been continuing to work in child psychiatry. I had a primarily non-pharmacologic intervention and treatment plan, but these comments were incredibly helpful.

I found the answers above very precise and on point. I will add that I have used with several kids who had SIBs, the opiate antagonist, naltrexone, with quite favorable results in many instances. Based on clinical response, I would always try to start with the lowest dose, a quarter of a 50 mg table...

I certainly agree with the emphasis on the underlying cause and treating it if found. When symptoms must be treated emergently, a benzodiazepine and/or antipsychotic can be helpful.

Naltrexone then lithium. 

I agree with the medical cause of behavior first because that is important not to miss and start unnecessary medications. If there is no improvement, increasing the dosage too much could lead to over-medication and worsen the medical condition.