A Review of Management Strategies for Aggression and Self-Injury in Youth With Autism Spectrum Disorder

Aggression and self-injury are common challenges for youth with autism spectrum disorder (ASD), often impacting safety, ability to access services and community resources, and quality of life for children, adolescents, and their families. As pediatricians and other pediatric primary care physicians are often tasked with managing these problems, this review outlines the evidence and potential strategies in both the assessment and management of aggression and self-injury for youth with ASD. Assessment begins with evaluating safety risks and identifying contributing factors, such as medical conditions, communication difficulties, environmental stressors, reinforcement patterns, and psychiatric comorbidities. Evidence-based behavioral interventions, including applied behavior analysis, functional behavioral analysis, functional communication training, and parent training programs, form the foundation of treatment, supplemented by school-based and protective equipment interventions where appropriate. Pharmacologic interventions may be considered when behavioral approaches are insufficient, but they show variable efficacy in managing aggression or self-injury.