A 14-year-old boy with autism spectrum disorder level 2 (requiring substantial support) is brought to the PMHNP by his mother for evaluation of escalating irritability and aggression over the past two months. He has been hitting his younger sibling, throwing objects when frustrated, and has had three episodes of self-injurious behavior involving head-banging. These behaviors have resulted in his suspension from his therapeutic day school program. His mother reports that the aggression worsens during transitions and when demands are placed on him. He has limited verbal communication and uses a communication device for basic needs. He is currently receiving applied behavior analysis services 20 hours per week. A functional behavioral assessment by his BCBA identified the primary function of the aggression as escape from demands. Medical workup including CBC, CMP, thyroid function, and urinalysis were normal. He had a dental evaluation that was unremarkable. His mother is requesting medication to help manage the aggression so he can return to school.