Paliperidone as an Alternative Treatment for Behavioral Symptoms in Childhood Autism: Case Report of an Eight-Year-Old Patient

This case report discusses an eight-year-old boy diagnosed with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and disruptive mood dysregulation disorder (DMDD), who required two separate psychiatric hospitalizations within a four-month period due to severe aggression and self-harming behaviors. The patient was initially admitted involuntarily under the Florida Mental Health Act of 1971 after exhibiting violent behavior toward family members and significant self-harm. During his first hospitalization, which lasted 25 days, he demonstrated a limited response to multiple combination interventions, including stimulants, α-agonists, and antipsychotics such as risperidone and olanzapine. Paliperidone, an atypical antipsychotic typically used in adolescents for schizophrenia, was titrated up to 3 mg/day, resulting in significant improvement in irritability and aggression with no immediate adverse effects. Four months after discharge, the patient was readmitted for similar behaviors, including aggression toward teachers and renewed self-harm. Despite adherence to his prescribed medications during the interim period, his symptoms returned abruptly, one week prior to readmission. During this second hospitalization, lasting 16 days, the dose of paliperidone was increased to 3 mg twice daily, based on the Florida Best Practice Psychotherapeutic Medication Guidelines for Children and Adolescents, leading to rapid resolution of aggressive episodes. The patient tolerated the dosage adjustment without significant side effects, though weight gain remained a concern. This case highlights paliperidone's potential utility in managing severe behavioral dysregulation in pediatric patients with ASD when first-line therapies fail. It also underscores the importance of careful monitoring for metabolic side effects in this vulnerable population. Further research is needed to establish age-specific dosing guidelines and long-term safety profiles for children under 12 years of age.