Risperidone for Children With Autistic Spectrum Disorder
Risperidone for Children With Autistic Spectrum Disorder
Introduction Atypical antipsychotic agents are widely used psychopharmacological interventions for autism spectrum disorders (ASDs). Among the atypical antipsychotic agents, risperidone has demonstrated considerable benefits in reducing several behavioral symptoms associated with ASDs. This meta-analysis examined research regarding the effectiveness of risperidone use among children with ASD using articles published since the year 2000.
Methods The database for the analyses comprised 22 studies including 16 open-label and six placebo-controlled studies. Based on the quality, sample size, and study design of studies prior to 2000, the database was then restricted to articles published after the year 2000. Effect sizes were calculated for each reported measure within a study to calculate an average effect size per study.
Results The mean effect size for the database was 1.047 and the sample weighted mean effect size was 1.108, with a variance of 0.18.
Conclusions Outcome measures demonstrated mean improvement in problematic behaviors equaling one standard deviation, and thus current evidence supports the effectiveness of risperidone in managing behavioral problems and symptoms for children with ASD. Although Risperdal has several adverse effects, most are manageable or extremely rare. An exception is rapid weight gain, which is common and can create significant health problems. Overall, for most children with autism and irritable and aggressive behavior, risperidone is an effective psychopharmacological treatment.
Autism spectrum disorders (ASDs) are chronic neuropsychiatric conditions characterized by marked impairment in social interactions, communication deficits, and restricted/repetitive patterns of behaviors (American Psychiatric Association, 1994). ASDs are associated with several problematic behaviors, including aggression, hyperactivity, irritability, repetitive behaviors or stereotypies, social withdrawal, and communication problems (Pennington & Ozonoff, 1996). Psychopharmacological interventions have been used widely to manage many of these symptoms (Correll, 2008). Specifically, atypical antipsychotic agents (AAPs) are widely used for the treatment of irritable and aggressive behaviors for children with ASD (Elvins & Green, 2010). In October 2006, the U.S. Food and Drug Administration (FDA) approved the use of risperidone, commercially known as Risperdal, in children and adolescents ages 5 to 16 years who have symptoms of irritability associated with ASD (Yan, 2007). Currently no AAP agents are approved for prescription in children younger than five years because of a lack of scientific evidence of efficacy and safety.
During the past decade, the use of AAP medications for ASD has expanded for the following reasons: practitioner training in the prescribing of psychopharmacologic agents for children with ASD has increased (West & Waldrop, 2006), research evidence favoring certain pharmacological treatments has emerged (Erickson et al., 2005, Stachnik and Nunn-Thompson, 2007), the numbers of children diagnosed with ASD has risen (Fombonne, 2006), and licensing to prescribe prescriptions for AAP agents has expanded from primarily psychiatrists to general pediatricians and nurse practitioners (Chavez, Chavez-Brown, Sopko, & Rey, 2007).
Despite their widespread use, the prescription of AAP medications in the pediatric population to manage behavioral symptoms of ASD continues to be a controversial issue for parents and the general public (e.g., Elias, 2006; Lilienfeld, 2005). Parents and some professionals are often wary of AAP medications (Weiss & Harris, 2001). These reasons include a lack of clear guidelines on adverse effects, the freedom of physicians and nurse practitioners to prescribe medication without FDA approval (i.e., off-label), the suspicion that monitoring of prescribed medications may not be conducted carefully and thoroughly, and serious and well-publicized case reports illustrating the dangers of AAP use in the treatment of young children (James, 2009, Tyrer and Kendall, 2009, Witwer and Lecavelier, 2005). For prescribing medical professionals, the primary issue is to consider whether the benefit-to-risk ratio is favorable for children with ASD. Furthermore, behavioral interventions without medications may be as effective without the potentially harmful adverse effects (Horner, Carr, Strain, Todd, & Reed, 2002). A detailed analysis of all outcome studies on the effects of AAP medications is a step toward developing consensus and guiding prescription practices.
Abstract and Introduction
Abstract
Introduction Atypical antipsychotic agents are widely used psychopharmacological interventions for autism spectrum disorders (ASDs). Among the atypical antipsychotic agents, risperidone has demonstrated considerable benefits in reducing several behavioral symptoms associated with ASDs. This meta-analysis examined research regarding the effectiveness of risperidone use among children with ASD using articles published since the year 2000.
Methods The database for the analyses comprised 22 studies including 16 open-label and six placebo-controlled studies. Based on the quality, sample size, and study design of studies prior to 2000, the database was then restricted to articles published after the year 2000. Effect sizes were calculated for each reported measure within a study to calculate an average effect size per study.
Results The mean effect size for the database was 1.047 and the sample weighted mean effect size was 1.108, with a variance of 0.18.
Conclusions Outcome measures demonstrated mean improvement in problematic behaviors equaling one standard deviation, and thus current evidence supports the effectiveness of risperidone in managing behavioral problems and symptoms for children with ASD. Although Risperdal has several adverse effects, most are manageable or extremely rare. An exception is rapid weight gain, which is common and can create significant health problems. Overall, for most children with autism and irritable and aggressive behavior, risperidone is an effective psychopharmacological treatment.
Introduction
Autism spectrum disorders (ASDs) are chronic neuropsychiatric conditions characterized by marked impairment in social interactions, communication deficits, and restricted/repetitive patterns of behaviors (American Psychiatric Association, 1994). ASDs are associated with several problematic behaviors, including aggression, hyperactivity, irritability, repetitive behaviors or stereotypies, social withdrawal, and communication problems (Pennington & Ozonoff, 1996). Psychopharmacological interventions have been used widely to manage many of these symptoms (Correll, 2008). Specifically, atypical antipsychotic agents (AAPs) are widely used for the treatment of irritable and aggressive behaviors for children with ASD (Elvins & Green, 2010). In October 2006, the U.S. Food and Drug Administration (FDA) approved the use of risperidone, commercially known as Risperdal, in children and adolescents ages 5 to 16 years who have symptoms of irritability associated with ASD (Yan, 2007). Currently no AAP agents are approved for prescription in children younger than five years because of a lack of scientific evidence of efficacy and safety.
During the past decade, the use of AAP medications for ASD has expanded for the following reasons: practitioner training in the prescribing of psychopharmacologic agents for children with ASD has increased (West & Waldrop, 2006), research evidence favoring certain pharmacological treatments has emerged (Erickson et al., 2005, Stachnik and Nunn-Thompson, 2007), the numbers of children diagnosed with ASD has risen (Fombonne, 2006), and licensing to prescribe prescriptions for AAP agents has expanded from primarily psychiatrists to general pediatricians and nurse practitioners (Chavez, Chavez-Brown, Sopko, & Rey, 2007).
Despite their widespread use, the prescription of AAP medications in the pediatric population to manage behavioral symptoms of ASD continues to be a controversial issue for parents and the general public (e.g., Elias, 2006; Lilienfeld, 2005). Parents and some professionals are often wary of AAP medications (Weiss & Harris, 2001). These reasons include a lack of clear guidelines on adverse effects, the freedom of physicians and nurse practitioners to prescribe medication without FDA approval (i.e., off-label), the suspicion that monitoring of prescribed medications may not be conducted carefully and thoroughly, and serious and well-publicized case reports illustrating the dangers of AAP use in the treatment of young children (James, 2009, Tyrer and Kendall, 2009, Witwer and Lecavelier, 2005). For prescribing medical professionals, the primary issue is to consider whether the benefit-to-risk ratio is favorable for children with ASD. Furthermore, behavioral interventions without medications may be as effective without the potentially harmful adverse effects (Horner, Carr, Strain, Todd, & Reed, 2002). A detailed analysis of all outcome studies on the effects of AAP medications is a step toward developing consensus and guiding prescription practices.