Medications for irritability and aggression in autism: what a large Cochrane review found

In one sentence

This large review suggests that some psychiatric medications may reduce irritability in autistic children and adults, but evidence for aggression, self-injury, and long-term effects is still much less certain.

What the researchers did

Researchers reviewed 131 studies involving around 7,000 autistic participants. Most studies involved children and teenagers, although some also included adults.

The goal was to understand whether different medications could help with difficulties such as irritability, aggression, emotional outbursts, or self-injurious behavior.

Many studies compared medications with placebo — pills that contain no active drug.

What they found

The clearest results were seen with a group of medications called atypical antipsychotics, including medicines such as risperidone and aripiprazole.

Across many studies, these medications were more likely than placebo to reduce irritability in the short term. For some families, this may mean fewer severe emotional outbursts, less tension, or fewer intense behavioral reactions.

However, when researchers looked at aggression or self-injury specifically, the evidence became much weaker and less certain. There were fewer studies, and the results were less consistent.

For other medication groups, including some ADHD medications and antidepressants, the evidence for benefit was generally smaller or unclear.

The review also found that side effects were common. Reported problems included sleepiness, appetite changes, dizziness, tremor, and other unwanted effects.

What this means for families and therapists

The review does not say that medications should always be used — or avoided. Instead, it shows that some medications may help some people, especially with severe irritability, but decisions need to balance possible benefits with side effects and quality of life.

It also highlights that medication is usually only one part of support. Sensory stress, sleep, communication difficulties, school demands, and the surrounding environment can all strongly affect behavior and emotional regulation.

For many families, this means medication decisions work best when they are part of a broader support plan rather than treated as a complete solution on their own.

The review also reminds therapists and clinicians that behavioral support and medical care should stay coordinated when medications are involved.

Limitations and what we don't know yet

Most studies lasted only a few weeks or months, so researchers still know relatively little about long-term safety and long-term benefits.

The studies also included very different autistic people with different support needs, ages, and co-occurring conditions. Because of this, average results from large groups cannot predict exactly how one specific person will respond to a medication.

The authors say more long-term, high-quality studies are still needed, especially around aggression, self-injury, and side effects over time.

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This is a simplified summary of Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD) by Iffland M., Livingstone N., Jorgensen M. et al., Cochrane Database of Systematic Reviews (2023).

Source license: CC-BY-NC-4.0.

This is not medical advice. Please consult a qualified healthcare professional before making treatment decisions.