As specified elsewhere on this website hyperness is always underestimated and misinterpreted.
to summarise again,
according to dr kondekars goal directed cognitive approach in autism kids hyperness behaviour is of 2 types:
1. type 1: with sound: these kids may have any one or many of the following: agitation, aggression, pinching, biting, shouting, screaming, throwing, tapping , banging, stamping, slapping, breaking, clapping, making loud sounds, loud words, making sounds from objects, switching buttons on and off, opening and closing fridge door, hitting hurting others or self... and many more
2. type 2 :without sound: these kids may have any one or many of the following: fidgety, restless, movements in sitting, squirming, often clearing the bottom, cannot sit like statue, touching here and there, on the go, walking, wandering, rhythmic movements, to and fro, on the go, getting carried away with eyes/hand/ feet, wandering, climbing on table / sofa/ chair / window, jumping, trying to touch at heights with hand, clumsy, careless, turning or moving head / eyes/ body parts, playing with pen pencil / books, tossing, spinning and many more
often these issues are annoying to others, but parents may find as innocent or negligible as they are used to it.
often there is pharmacology treatment / control medicines for such behaviours which is very effective to show results in 2 to 5 days, the results need to be sustained by titrating the doses on weekly or monthly basis as needed to keep the child is full control of these diverting behaviours which make the child lose focus in learning. Therapy doesnot work effectively despite months to give same results what the medicines can give in a week, Medicines are needed to turn the child therapy able. not using medicines wastes time and crucial years of learning. Also, when we plan to stop it my non medical means, often force is used by shouting/ punishing or stopping with physical restrain which can also precipitate aggression sooner.
according to dr kondekars goal directed cognitive approach
how parents underestimate the problem or its severity:
1. they avoid telling these issues to doctor, as to some extent they feel it is normal... even if its annoying to other
2. they try to justify saying,
kids shall do it, it is like normal, its only in retaliation, its only once in a day, he hurts only when we ask xyz, or snatch xyz or trouble him or saying that his father alkso used to do same in child hood, its just little, he doesnt do it at home or school or saying that he doesn only when i dont give medicines or he does with only in presence of xyz etc
3. they will try to justify saying it was a lot in past andnow its little
4. therapist may justify saying he is cooled down a lot.
5. oh he needs that sensory stimulation is another justification. if i do this/ give this etc he wont do it.
6. and many more reasons: like even doctors saying he doesnt need x y z medicine
all these reasons make a doctor undertreat the annoying behaviour. all these reasons will also make the parents reduce the doses of control medicines on their own or by forcing teh doctor to do so
and then problem perisist saying, it all same despite treatment with medicines.
according to dr kondekars goal directed cognitive approach
MEDICINES ARE NO MAGICAL WANDS, THE NAME OF THE MEDICINE DOESNT MATTER, THE DOSE AND FREQUENCY NEEDED IS DECIDED BY THE SEVERITY AND FREQUENCY OF ISSUES.
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according to dr kondekars goal directed cognitive approach
WHY PARENTS / PATIENTS TEND TO STOP OR REDUCE MEDICINES ON THEIR OWN:
1. commonest reason is inconvenience that it has to be taken daily or many times a day even though they are cheap. often we may need higher doses or added medicines taht adds to inconvenience.
2. cost is just another factor even if parents disagree. as often dr / therapy visits may be frequent and so does fees.
3. the scare about control medicines created by non allopath / paramedics and therapists/ doctors; despite not having many major side effect, dependency or addictive potential; if given as per doctor prescrpition. trsut me they are safe, and needed for quality of life.
4. often parents tend to give low dose saying that high dose caused sleep. remeber that sleep realted to any control medicines may not last more than 5 days if given regularly. even if sleep, dose may need to be tapered by doctor for a week and again needs to be pulled up. once a kid has slept with xyz dose doesnt mean he will sleep each time.
5. some parents will say we stopped medicine because he got hyper on stopping the dose. it happened because he needed daily dose and not stopping for some period.
6. some parents will say we stopped medicines because he turned aggressive with the medicine. often its vice versa, the medicine may have given to tackle aggressiveness. for some medicines like risperidone- aggression coming up may need doubling the dose. for some medicines like atomoxetine, aggression coming up new may need reducing the dose. very rarely say one in 100000 may have a situation that it doesnt suit. but then we do have alternatives. not treating is not a solution.
7. and parents often say that we stopped because we donot knwo how long. but that doesnt solve the problem, not havinbg enough control means school will suffer. having a shadow teacher is not a solution to tackle hyperness. if instead of help in teaching she is used only to hold the child with hand, aggression is likely to worsen.
according to dr kondekars goal directed cognitive approach
how long do these kids will be needing control medicines to treat ADHD:
- its very simple. till the time problem is.
- till the time child evolves out of the disability.
- till the time, 2 years symptom free phase is noted.
- till the time, we develop verbal understanding in the child enough to understand counselling and child can control or manage even outbursts with his own control of thoughts and mind through is verbal thinking and understanding, like say with the help of cognitive behaviour therapy and meditation as needed.
- yes even some adults do need such treatment and 30% autism may have chance to turn into schizophrenia and sometimes even a 40 year old may start with need for control medicines due to this disorder of thought and feelings.
Managing aggression in children—especially those with developmental conditions such as Autism spectrum disorder—requires a structured, compassionate, and individualized approach. Treatment is rarely based on one medicine alone. Instead, it follows a layered model that addresses root causes, co-existing conditions, and developmental understanding.
1. Treat underlying medical or physical triggers first
Aggression often worsens when a child is uncomfortable but unable to clearly communicate distress. Common triggers include constipation, cold or flu symptoms, pain, dental problems, ear infections, sleep disturbances, or gastrointestinal discomfort. Even mild physical issues can significantly increase irritability. Behavioral conditions such as attention difficulties, hyperactivity, impulsivity, anxiety, or frustration intolerance may also contribute. Before starting or escalating psychiatric medications, these reversible causes must be identified and treated. Addressing pain or discomfort alone can sometimes significantly reduce aggressive behavior.
2. Add prescribed medication when needed
If aggression persists despite addressing underlying issues and behavioral strategies, a doctor may introduce medication. The choice depends on the child’s diagnosis, age, severity of aggression, associated symptoms (such as irritability, hyperactivity, mood swings, or anxiety), and medical history. Medications are always prescribed by a qualified physician, and parents should never start, stop, or change doses independently. The goal is not sedation but emotional regulation and improved functioning.
3. Start low and increase gradually
Most medications used for aggression are started at sub-therapeutic (low) doses. This allows the doctor to monitor tolerance and side effects before increasing gradually to a therapeutic level. Dose adjustments are based on response, weight, age, and side effect profile. Some children respond to very small doses, while others require gradual titration over weeks. Regular follow-up is essential to ensure safety and effectiveness.
4. Stepwise or serial medication approach in autism
In children with Autism spectrum disorder, aggression may be part of irritability, sensory overload, communication difficulty, or rigidity. Several classes of medications are available to manage severe irritability or aggression, and doctors may adjust, switch, or combine medications in a structured manner. Changes may occur weekly or monthly depending on response. Treatment is individualized—what works for one child may not work for another. Behavioral therapy, sensory regulation strategies, speech therapy, and parent training remain equally important alongside medication.
5. Environmental and behavioral triggers
Aggression can worsen due to teasing, excessive pampering, inconsistent boundaries, abrupt denial of requests, or physically restraining a child without preparation. Clear communication, predictable routines, calm redirection, and structured limits reduce escalation. Behavioral therapy helps parents respond consistently and avoid reinforcing aggressive behavior.
6. Developmental understanding of emotions
As children become more aware of their environment, they begin to experience complex emotions—fear, frustration, stranger anxiety, jealousy, and anger. In some developmental conditions, emotional regulation may resemble that of a much younger child (for example, 14–18 months developmental level), even if the chronological age is higher. Aggression may simply be an expression of overwhelming feelings rather than intentional defiance.
Ongoing dose adjustment and monitoring
All treatments—medical, behavioral, and environmental—require regular review. Growth, developmental changes, school demands, and stressors can alter behavior over time. Dose adjustments should always be supervised by a doctor, with careful monitoring for benefits and side effects.
A comprehensive, patient, and multidisciplinary approach provides the best long-term outcomes for managing aggression safely and effectively.
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