Evaluating and managing irritability and aggression in children and adolescents with autism spectrum disorder: An algorithm

A range of maladaptive behaviors, including irritability and aggression, are often encountered in autism spectrum disorder. Challenges in complex clinical decision making and management exist, and off-label antipsychotic prescribing is increasing in Canada. A literature review of various treatments, limited to randomized controlled trials in the pediatric population, was used to develop an algorithm for evaluating and managing irritability and aggression in autism spectrum disorder within a Canadian context, which is supported by expert consensus. Holistic consideration of biomedical, psychiatric, psychosocial, environmental, and developmental factors that affect behavior is emphasized. The algorithm highlights the multifactorial contributors to irritability and aggression in autism spectrum disorder and reserves the use of antipsychotic medication for managing the most severe and refractory cases. A comprehensive evaluation of the drivers of behavior when addressing irritability and aggression in autism spectrum disorder is crucial to identify treatable contributors and institute appropriate management.