I think your best bet is going to be to try a combination of ABA and medication. I do understand how you feel my daughter was like this and I have been there. My daughter not only hurt others but hurt herself as well. We did get improvement from the ABA both in school and three hours a day after school plus we had her on various different meds.

In the end though we had to have her put in residential treatment because she only went so far. She is only 7 but I can tell you she has been there for a few months now and has not had one tantrum or instance of hurting anyone else since being there. She does still pinch and hurt herself a bit but it is down at least 75% of what it was.

The key to these situations is to get the child help early because the longer you let it go the worse it gets. I know at my daughters school they have a very high success rate of children transitioning from the residential home to the day program after a few years of treatment.

I know this is very hard, and it is the worst thing we have had to go through but our daughter is much better off than she was and the path we were heading down was not going to help her or anyone else. I know this is tough but you cannot feel bad that you cannot stop it and you cannot feel bad that others do not want their child around yours because it is something you cannot handle on your own.

I know people are against both meds and against residential but you have to do what is best for the child.

@A MyAutismTeam Member is absolutely correct. Understanding the Antecedent to a behavior is crucial in learning how to eliminate it. You can try a reward system for appropriate behavior. At first it's daunting because you're working with 5 minutes at a time. Whatever your child's absolute favorite activity is... can be EARNED. Meaning...he can not have access to that activity UNLESS he is able to control his behaviors. You can start by timing him for 5 minutes at a time. Each time the timer goes off, he earns a smiley face....for not becoming aggressive. Then the timer is set for another 5 minutes...and he can earn another smiley face for not becoming aggressive. The number of smiley faces is up to you. But the idea is...when he gets more smiley faces/day than incorrect frames .... you can move the five minutes segments to 10 minutes each. Still setting a timer for 10 minutes. When it beeps, and he hasn't had a behavior, he gets a smiley face. And you move up from there. As a therapist, we require our clients to get 80-100% correct time frames for 2 days in a row before adding the 5 minutes to the timer. Slowly but surely...your child will realize he can ONLY earn his favorite activity by keeping his aggression under control. Of course...I also recommend ABA therapy because we are trained to create programs that deal with your child's specific behavioral, cognitive, social and emotional needs. No two children are alike. ABA therapy is beginning to be accepted as a medical necessity. You should check your state's views on this, our services could be covered by your Health Insurance.

Oh wow that sounds fantastic! We struggle to find causes because some days it will be alllll day long that he is aggressive with no changes in environment etc. We are in really early stages and are waiting for an early intervention treatment plan from Max's doctor so I am just totally on my own until were get that call. I am so grateful for the internet!

Do you have a Board Certified Behavior Analyst on your son's team? They can do a functional behavior analysis which looks at what occurs before the behavior that could trigger it, exactly what the behavior is comprised of, and what occurs after the behavior that might be reinforcing it. Once this has been done a number of times the function of the behavior can be determined and a behavior plan can be put in place to help everyone consistently deal with the behavior in the same way to get the best results. We have done this a lot with both of my kids and it has not only helped us with problem behaviors, it has also helped us to determine that some behaviors were due to pain caused by an underlying medical condition that might not have been diagnosed for years were we not taking consistent data on the behaviors. Because of this my daughter was scoped and diagnosed with a rare eosinophilic disorder (white blood cell) that was causing her a great deal of pain while doing irreparable damage to her esophagus. Had we let it go for years assuming that the screaming, aggression and insomnia were all down to autism she could have permanently lost the ability to swallow. I am a big fan of Functional Behavior Analysis.

Thanks everyone for your help! I will try all of your suggestions. I'm having a really hard time figuring out the 'why' but hopefully as we get more support and resources I can get some more clues. :)