Difficult-to-Treat Aggression in a Child with Autism Spectrum Disorder: Did We Miss Something? Bipolar Disorder As a Comorbid Psychiatric Condition in Autism Spectrum Disorder

Chief Complaint and Presenting Problem C. was a 16-year-old adolescent boy with a history of autism spectrum disorder (ASD), intellectual disability (ID), and cerebral palsy (CP) who was brought to the emergency department (ED) by his mother due to worsening aggression and erratic behavior. Mirtazapine 15 mg po qhs was continued for mood and sleep; clonidine was discontinued, and he was started on risperidone 1 mg po qhs for aggressive behavior in the context of ASD, ID, and CP. Educational History C. was in the 10th grade at special education private school where he received accommodations for ID and ASD. Risperidone was increased up to 2 mg po qhs, but subsequently discontinued due to side effects of cramps in the right calf, and aripiprazole 5 mg po daily was started for aggressive behavior.