Aggression

Abstract

Aggression, self-injurious behavior, and behavior changes are reported in many patients with intellectual disability and are the chief complaint or a complicating factor in many healthcare visits. When evaluating patients with intellectual disability, it is important to consider biological, psychological, and social factors that may contribute to aggressive behaviors including medical problems, pain, grief, reaction to change, feeling unsafe, and psychiatric disorders, among others. The biopsychosocial model in evaluation emphasizes a calm environment, an evolving approach, and a thorough evaluation including history, risk factors, and collateral sources. This chapter provides information on common presentations of behaviors and considerations of medical conditions, medical workup, and information gathering from caregivers and the patient. It also provides up-to-date information on both non-pharmacological and pharmacological treatment of aggression in the ID population. When using a pharmacological intervention, it is important to consider underlying conditions as well as comorbidities and side effects when making a medication choice. While antipsychotics are the most widely used, there is evidence that other, potentially less harmful medications can be helpful, especially when there is an underlying mood or anxiety disorder or underlying ADHD. It is also important to consider lowering the dose of medication or discontinuing the medication when able, as research has shown success in doing so without return of aggressive behavior.