Impulsivity like behaviour in an autism kid

Good evening everyone.. One Austism patient of mine, impulsively breaks glasses. He is brought with two people holding his both hands. I and my social worker remove my spectacles and put our phones into hiding once he comes, upon his mothers request. Yet he is restless, tries to spot the hidden glasses. Same with glass partitions in the fridge and any other glass items. Tried Risperidone to reduce the aggression. But not responded. Does this phenomena respond to Fluoxetine like stereotypies? Are there any other recommended drugs?

Answer:

Ma'am, it looks like type I or Type II Self Injurious Behavior. An anticonvulsant would be the first line(Sodium Valoroate is the safest, followed by Oxcarbazapine). Do also look for an underlying seizure activity on the EEG:indication of newer anticonvulsants(use with caution:risk of Forced Normalisation, Alternating Psychosis of Epilepsy:Krishnamoorthy and Trimble criteria Epilepsia 1996. 

If an adolescent, LFT is alright, Naltrexone can be tried.

If he is not a diabetic, one alternative would be to try the Olanzapine Fluoxetine Complex(5/20mg), there, before trying anticonvulsants

Is there an underlying severe Sensory Processing Disorder?

Other non pharmacological treatments for the same.

Ma'am, if he breaks glass, do ensure whether he likes the sound of broken glass or breaks it to feel pain. Dr Paul Russell, from CMC, Vellore has described this in a lot of detail there.

If he breaks the glass, he should have obviously gotten hurt somewhere or to some degree. This appears to be an endogenous numbing of the pain response, that has been described very well in severe degrees of a pervasive developmental disorder. Is it this phenomenon you are seeing? If so, activation of pain responses is important. Naltrexone is known to be helpful.

It is in this phenomenon that when Naltrexone cannot be given, a SSRI based on the symptomatology might help, in increasing the pain response along with dampening of the behavioral aggression, that in all probability is not voluntary; is clearly a sensory issue.