Can high-dose propranolol reduce severe aggression in autistic adolescents? A small pilot crossover trial suggests promising improvements, though cardiovascular monitoring remains essential. We examine the data, practical limitations, and how this approach fits into a thoughtful, stepwise treatment algorithm.

Pathological demand avoidance (PDA) is a popular concern among autistic kids and families. It’s not in the DSM, yet we need to understand and address it. This clinical update helps you approach irritability and PDA rationally to help autistic patients connect and regulate before merely prescribing D2-blocking antipsychotics. 

Lithium is FDA-approved for bipolar disorder in children and adolescents 12 years and up; however, its potential off-label utility is broad, from affective aggression to anorexia nervosa. This clinical update covers how to prescribe lithium for children and adolescents and how to talk with patients and parents about lithium. 

Antipsychotics offer remarkable, even lifesaving treatment for children and adolescents, however, their side effects include metabolic and neurologic problems, including neurotoxicity. This clinical update guides you through a rational process for employing these powerful medications when necessary but also reducing and discontinuing them when possible.

Are stimulant medication likely to exacerbate anxiety in ADHD kids? It’s reasonable concern, especially since mood symptoms can be worse with withdrawal and heart rate goes up in some kids on stimulants. This study gives nuanced insight into the degree to which stimulants impact anxiety in ADHD kids, for better and worse.