When they hit, bite or break things

Being hurt by your own child is a shock, at 4 or at 40. It is also common: in one study of 1,380 autistic children and teens, 68% had been aggressive to a caregiver. It was not linked to IQ or to how severe the autism looked. It is not a measure of your love. In another study, physical aggression was higher in young autistic children, then evened out.

In the moment

1. Get the other children out.Go to your room and shut the door. I will come and get you.
2. Step back, out of arm's reach, with the door behind you. (Close contact is how most people get hurt.)
3. Drop the demand and go quiet. (Low, calm voice. Do not stare, argue, lecture or threaten.)
4. Turn things down. (TV off, lights down, fewer people. Give it time.)
5. Move objects, not the person. (Push hard or sharp things away. Let them move. Holding is a last resort, even for professionals.)
6. Still coming at you? Leave. Take your phone to a room you can lock. (Call someone from there. Never lock them in.)

Meltdown, or hitting with a job? A meltdown is “an intense response to an overwhelming situation,” the National Autistic Society says. Other hitting ends a demand or gets something. Often it is both. Either way, safety comes first and the reason comes later.

Set up the house on a calm day

• Two ways out of the main rooms, and no dead-end hallways.
• Fix shelves, pictures and lamps to the wall. (Anything loose can be thrown.)
• Guns: the safest home for a child has none. (Otherwise locked and unloaded, with the ammunition locked apart.)
• Give them a quiet place of their own. (To retreat to by choice. Never a locked room.)

Head-banging and safe rooms: Safety. Right now: the hitting card.

Police, and lowering the risk

A 911 call can bring police first, and the person may be handcuffed. In 2020, a Salt Lake City mother asked for crisis-trained officers for her autistic 13-year-old. She warned he might run. Officers chased him, and one shot him.

• No one in immediate danger? Call or text 988 first. (It can avoid police.)
• Ask for a CIT officer. (A 40-hour crisis course. Not every officer has it, and it is no guarantee.)
• At the door, say it is a crisis, then step back. (More: police and 911.)
• Teach them never to reach into a pocket near police. (Autistic advocates warn it can look like reaching for a gun.)

Check these first

Behaviour may be “the primary or sole symptom” of a medical problem, an expert panel wrote. Ask the doctor to rule out:

• pain, including teeth and ears
• constipation, reflux and other gut problems
• seizures
• poor sleep, especially waking at night
• allergies, or a change in sight or hearing
• periods (A small study found worse premenstrual symptoms in autistic women.)
• medicines (Levetiracetam, for seizures, and montelukast, for asthma, both list aggression as a possible effect.)

Then the rest: no easy way to say “stop” or “help”; noise, light and crowding; demands and changes; anxiety, depression or ADHD; puberty. New hitting after a new school, bus or carer? Ask whether someone is hurting them.

Right after

1. Bitten, and the skin is broken? Wash it with soap and warm water, then get it seen today. (The NHS says any human bite needs urgent advice.)
2. Hit on the head? Get help now for vomiting more than once, drowsiness, confusion or a bad headache.
3. Once they are calm, check them for injuries too.
4. No demands, and no telling off. (It can flare again quickly.)
5. Go to the other children. (Ask how they are. Plan with them for next time.)
6. Write three lines. (Before, during and after. Add sleep and food. A video helps the doctor too.)

Getting worse fast? Call the doctor today. (They may send you to the ER.) New but steady? Call this week.

Stopping the next one

1. Ask for a functional behaviour assessment. (It finds what the hitting is for, so a safer way can replace it.)
2. Give them a way to say “stop,” “help” and “no.” (Words, signs, pictures or a device.)
3. Ask about parent training.
4. Treat sleep. (Keep a 2-week sleep diary. Loud snoring or choking? Ask about sleep apnoea.)
5. Warn before changes. (Picture schedules, countdown timers.)
6. Write the crisis plan and give it to everyone who helps. (Warning signs, what helps, what never to do, who to call, which hospital.)

The assessment looks at triggers, patterns, the need behind the behaviour, and what follows it. A psychologist or behaviour specialist usually does it. Positive Behaviour Support, the plan that follows, “never uses punishment.” At school: when they keep calling.

Functional communication training teaches a clear way to ask for what the hitting was getting. A 2025 analysis found large drops in challenging behaviour, though only 29% of its studies met quality standards. AAC needs no prerequisites, and may even help speech.

Parent training works too. In a 2015 trial of 180 autistic children aged 3 to 7, 68.5% improved, against 39.6% with information sessions alone.

Ask what the goal is. The Autistic Self Advocacy Network opposes therapy that trains autistic people “to act non-autistic.”

Medicine, plainly

Two medicines are FDA-approved for “irritability” in autism, which includes aggression. Risperidone (Risperdal) was approved in 2006 and aripiprazole (Abilify) in 2009. Labels cover ages 5 to 17 and 6 to 17. For adults, a 2025 Cochrane review found one small trial.

The benefit is real. In the 2002 risperidone trial, 69% of children improved, against 12% on a dummy pill. A 2024 review found only these two drugs, and parent training, strong enough to recommend.

So are the side effects. On risperidone in the autism trials, 63% were sedated and 44% were hungrier, against 15% each on dummy pills. Children gained 2.7 kg in 8 weeks, against 0.8 kg. On aripiprazole, 18% had movement side effects such as stiffness or tremor, against 2%.

• Ask for weight, blood sugar and cholesterol checks. (Both labels say to monitor.)
• Ask what you are measuring. (NICE: review at 3 to 4 weeks, and stop at 6 if there is no clear response.)
• Ask for the lowest dose, one drug, a behaviour plan alongside, and a review every 6 months.

Doctors may also treat ADHD, anxiety or sleep. Guanfacine eased hyperactivity in one trial. For other drugs, the evidence is thinner.

When you need more help than you have

• Call or text 988. (Free, any hour, and you may call about someone else.)
• Ask whether a mobile crisis team can come. (Not every area has one. Federal guidance says they should serve people with developmental disabilities.)
• Ask your state disability agency about START. (A 24/7 crisis service for people 6 and up with a developmental disability and mental health needs.)

Certified START programmes run in California, Colorado, Idaho, Iowa, New York, North Carolina and Tennessee. Six more states have programmes or START-based services, sometimes in only part of the state. In one small study, ER visits fell after START began.

The ER

In 73,624 ER visits for a mental health crisis, autistic children had almost 4 times the odds of waiting over 48 hours for a bed.

• Bring a one-page summary. (Diagnoses, medicines, how they communicate, what calms them. The free Emergency Information Form works.)
• Bring their communication device and comfort things.
• Expect hours of medical checks first. (A hold against their will is possible. Rules differ by state.)
• Ask staff to avoid restraint, and tell them what helps instead.
• Stuck for days, or worried about their rights? Call your Protection and Advocacy office. (Every state has one.)

Twenty US psychiatric units specialise in young people with autism and other developmental disabilities. Ask your doctor on a calm day which one you would want.

When they are an adult, and bigger than you

About 1.3 million Americans with developmental disabilities live with a caregiver over 60. Parents describe sons of 200 pounds or more, and nowhere to turn.

• Try not to be alone with them at the hardest hour. (A second adult at bath time or bedtime.)
• Get on your state's waiver list now. (They can pay for respite and personal care. How.)
• Tell the state disability agency, in writing, that home is not safe. (Ask about crisis help, emergency respite and placement.)
• Over 18? Check who can make medical decisions. (Smaller tools first: guardianship and the alternatives.)

A group home or residential placement is a faithful path. So is staying home with more help. Families who choose either have usually fought hard. More on both.

If police charge them

• Get a defence lawyer, and tell them about the autism at once. (Can't afford one? Ask for a public defender.)
• Ask for communication support at every interview and hearing. (The Arc warns of false confessions and wrong guesses about competency.)
• Ask about diversion to services. (Often only for non-violent cases, and not offered everywhere.)

Brothers and sisters

Siblings tell the charity Sibs they feel unsafe when a brother or sister is violent. Feeling they must just put up with it harms them.

• Make a safety plan with each child. (Where they go, who they call, and that leaving is always allowed.)
• Give them a room with a door that locks.
• Give them time that is just theirs. (Sibshops are peer groups for school-age siblings.)
• Let them say the hard feelings out loud. (Love and anger often sit together.)

You

Being hurt by your child can be trauma. In one study of 27 mothers, 6 had PTSD from events like being attacked. In a small study, EMDR, a trauma therapy, eased PTSD in all 7 parents.

• Tell your own doctor how you are sleeping and coping. (Ask about trauma therapy.)
• At the end of your rope? Call or text 988.
• For local services, call the Autism Society helpline: 1-800-328-8476.

If it's just you

• Keep your phone charged and on you.
• Pick one neighbour and a code word that means “come now.”
• Ask your church for a second adult at the hardest hour. (What a church can do.)
• Need a person tonight? The numbers.

Sources

All read on October 3, 2026. Our biases, out loud: we lean toward big trials and mainstream US and UK sources. The AI assistant that helped research this leans toward establishment sources and hedged wording.

1. NICE: autism in under 19s, CG170 and challenging behaviour and learning disabilities, NG11.
2. Challenging Behaviour Foundation: Positive Behaviour Support planning and physical interventions.
3. Autism Speaks: Challenging Behaviors: A Roadmap for Families, 2024.
4. National Autistic Society: meltdowns. Braddock and Rowell: Making Homes that Work.
5. Siblings: Sibs, staying safe and needs of young siblings; Sibling Support Project.
6. How common, and causes: Kanne and Mazurek, 2011; Quetsch and others, 2023; Buie and others, 2010; sleep, Mazurek and Sohl, 2016, and Hatzell and others, 2026; periods, Groenman and others, 2026; labels for levetiracetam and montelukast.
7. Behaviour help: NCAEP evidence-based practices, 2020; Blair and others, 2025; ASHA, AAC; Bearss and others, 2015; Autistic Self Advocacy Network, What We Believe.
8. Medicines: labels for risperidone and aripiprazole; McCracken and others, 2002; Cochrane, 2025; Choi and others, 2024; Scahill and others, 2015; approval dates, Otsuka and The Pharmaletter.
9. Crisis: SAMHSA, 988 FAQ; START locations; Kalb and others, 2019; CMS, crisis services guidance, 2025; hospital stays, Cohen and others, 2026, and Siegel and others, 2025.
10. Police: NAMI, calling 911 and CIT; County of Sonoma, 911 guidelines; KSL, the Salt Lake City shooting, 2023.
11. Adults and the law: Milbank Quarterly, 2026; Medicaid.gov, 1915(c) waivers; NAMI, criminal justice guide, 2026; The Arc.
12. Injuries and guns: NHS, bites; MedlinePlus, head injury; AAP, guns in the home.
13. Parents: Schnabel and others, 2020; Stekkinger-de Vries and others, 2025; Autism Society helpline.
14. Families: CBC, KFF Health News, the National Council on Severe Autism and Mumsnet, 2017 to 2022. Posters not named.