Divalproex for Managing Aggression and Irritability in Children with Autism Spectrum Disorder: A Systematic Review

Area of Science:

• Neuroscience
• Pediatric Psychiatry
• Pharmacology

Background:

• Aggression and irritability are significant challenges in children with autism spectrum disorder (ASD).
• Pharmacological interventions are often necessary, with divalproex used off-label despite unclear efficacy.
• This review assesses divalproex's effectiveness and safety for these symptoms in pediatric ASD.

Purpose of the Study:

• To systematically review the efficacy of divalproex in managing aggression and irritability in children with ASD.
• To evaluate the safety profile and adverse effects associated with divalproex treatment in this population.

Main Methods:

• A PRISMA-guided systematic review was conducted, searching major biomedical databases.
• Studies included children with ASD treated with divalproex, valproic acid, or valproate sodium.
• Data extraction focused on study design, interventions, outcomes, and adverse events.

Main Results:

• Ten studies (3 RCTs, 1 open-label, 6 case reports) met inclusion criteria.
• Intravenous divalproex rapidly reduced aggression, indicating potential for acute stabilization.
• Oral divalproex showed inconsistent efficacy for chronic symptoms; adverse effects included weight gain, sedation, and behavioral activation.

Conclusions:

• Intravenous divalproex may be beneficial for acute aggression management in pediatric ASD.
• The role of oral divalproex in chronic symptom management is uncertain due to inconsistent results and side effects.
• Regular serum monitoring and consideration of alternatives are recommended for chronic use.