The question bank is the fastest way to start, but PMHNP Helper also includes board-review planning, student resources, and plain-English guidance for psychiatric nurse practitioner students who are still learning the exam landscape.
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.
Explanation
For clinically significant irritability and aggression in adolescents with ASD, risperidone and aripiprazole are the only FDA-approved pharmacological treatments. Risperidone, starting at 0.25 mg daily with gradual titration, is a well-supported first-line option for this indication. Pharmacological treatment should be combined with behavioral interventions informed by functional behavioral assessment. In this case, the escape-maintained function of the aggression should be addressed through environmental modifications, functional communication training, and graduated demand presentation. Metabolic monitoring is essential and includes baseline and ongoing assessment of weight, fasting glucose, lipid panel, prolactin, and waist circumference. The goal of medication is to reduce the intensity of irritability and aggression to a level that allows the patient to engage with and benefit from behavioral and educational programming.
Key Takeaway
Risperidone and aripiprazole are the FDA-approved first-line pharmacological treatments for irritability associated with ASD in youth, requiring comprehensive metabolic monitoring and concurrent behavioral intervention informed by functional behavioral assessment.