Using antipsychotics for behavioral problems in children

ABSTRACT

Introduction: Antipsychotic use in children has increased over the past two decades. Randomized controlled trials have evaluated the efficacy of antipsychotics in autism spectrum disorder (ASD) and disruptive behavior disorders (DBD).

Areas covered: The authors systematically analyze the results of randomized controlled trials of second and third generation antipsychotics for irritability in ASD and aggressive and disruptive behavior in DBD with or without low IQ and ADHD. The aim of the review is to assist healthcare professionals to optimize therapy in this population.

Expert opinion: There is evidence to support the short-term efficacy of risperidone and aripiprazole for irritability in ASD, and short-term efficacy of risperidone for aggressive and disruptive behavior in DBD, although the benefits are closely balanced with an increased risk of metabolic, hormonal and extrapyramidal adverse effects. The use of antipsychotics in children with these disorders should be reserved for those refractory to first and second-line therapies, and in whom there is a persistent and serious risk of harm to self or others. Antipsychotics should be considered a short-term strategy while psychosocial and behavioral therapies are continuously employed.

KEYWORDS:

• Atypical antipsychotics
• aripiprazole
• risperidone
• lurasidone
• quetiapine
• autism spectrum disorder
• disruptive behavior disorders
• oppositional defiant disorder
• conduct disorder
• aggression
• irritability
• children
• adolescents

Article highlights

• Evidence for the use of antipsychotics in the treatment of aggression and irritability in children with ASD and DBDs has steadily increased over the past few years.

• Risperidone and aripiprazole have demonstrated efficacy for the treatment of irritability in ASD.

• Currently, only risperidone is supported with evidence for the treatment of aggression in DBDs.

• Psychosocial and cognitive behavioral therapy is the mainstay of treatment for mild to moderate case presentations. Antipsychotics are reserved for short-duration therapy for severe case presentations.

• ADR must be anticipated and monitored delingently through available evidence-based guidelines.

• In order to optimize therapy, future investigations should focus on individual factors which may effect the efficacy and safety of antipsychotics.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Funding for this article was provided by the Owerko Centre, Alberta Children’s Hospital Research Institute.