What pharmacological management do you consider in patients with Autism Spectrum Disorder whose primary behavior is aggression?

As with all of my child patients, my approach is never to medicate behavior but rather to medicate suffering. This means that I view “aggression” of all forms as a kind of communication that something is wrong inside and that other means of effective communicating or managing that discomfort or whatever is creating it are unavailable. So before I jump in with medications I do my best to learn where the triggers are for a particular child, what hurts, and what helps. Getting inside that child’s s...

There are a few medication options at your disposal:

Guanfacine has been mentioned and is an easy first-line to work with. Make sure you are aware of the different pharmacokinetic profiles between Intuniv and Tenex: it is NOT a 1:1 ratio with dosing. Clonidine can also be used but will require more frequent dosing (TID or QID) unless you have access to Kapvay.

Melatonin targets sleep. There is research showing this specifically helps with behaviors during the day. Clonidine QHS can also be used....

Dr. @Dr. First Last made some excellent points in her answer, but the question was what medications might be considered. We should always do as full an evaluation as possible, including how the psychology of the child is interacting with her environment, family stress, internal stress, etc. We can look for genetic causes, heavy metals, etc., but there comes a point where chasing after zebras may prolong suffering. Further, except in the case of central auditory processing Dr. Cohen mentioned, th...