DISRUPTIVE BEHAVIOUR

Using Risperidone in Children with Disruptive Behavior

Using Risperidone in Children with Disruptive Behavior

Introduction

Autism is a lifelong, biologically based, neurobehavioral, multidimensional disorder that affects verbal and nonverbal communication, physical and verbal social interactions, and daily routines and activities (National Institute of Child Health and Development [NICHD], 2004). The Diagnostic Statistical Manual IV (DSM-IV) (American Psychiatric Association, 2002) defines the core criteria for autism as (a) poor shared social interaction, (b) impaired communication and imaginative play, and (c) very limited and narrowed interests and activities. Autism, however, also is a heterogeneous disorder with each person having specific individual needs, deficits, and strengths. There is no cure for autism; no single drug or therapy has proven effective for treating the core deficits of autism. Although the overall goal of autism treatment is to help the individual function normally or near normal in society (NICHD, 2004), the goal of specific autism therapies is to treat particular symptoms such as disruptive behavior.

Children and adolescents with autism can display disruptive behaviors such as hand-flapping, hyperactivity, tantrums, aggression, head-banging, hitting himself or herself, and other self-injurious behaviors. These types of behaviors have created challenges and barriers for teachers, caretakers, and medical professionals. In an attempt to control the disruptive behavioral symptoms of autism, medical providers are prescribing psychotropic drugs. However, the United States Food and Drug Administration has not approved these drugs for the treatment of autism in children. Conventional neuroleptics have been used to treat the more aggressive and violent behaviors associated with autism; however, their side effects often are considered unacceptable. Haloperidol, for example, has been used with some success. However, it is used sparingly due to the high risks of extrapyramidal symptoms (e.g., dystonia, parkinsonism, akathisia) with a risk of tardive dyskinesias in 32.2% of participants within the first six months of initiating therapy and withdrawal dyskinesias in 28.8% of participants (Malone, Maislin, Choudhury, Gifford, & Delaney, 2002; McCracken et al., 2002). As a result, atypical antipsychotic drugs are being studied as off-label medications to treat autism because of their increased safety and efficacy over conventional neuroleptics. Risperidone is becoming one of the more popular atypical antipsychotic drugs prescribed for treating disruptive behavior in autistic children. This discussion will explore the use of risperidone as a possibly safe and potentially effective treatment for disruptive behavioral symptoms in children with autism.

Review of Literature

At the time of this review, few articles have been published on the use of risperidone in children with autism. Masi, Cosenza, Mucci, and Brovedani (2001) studied the safety and efficacy of low dose risperidone in 22 autistic children ages 3.6 to 6.6-years-old. Using the Clinical Global Impressions

Improvement (CGI-I) four point scale, Children's Psychiatric Rating Scale (CPRS), Childhood Autism Rating Sale (CARS), and Children's Global Assessment Scale (C-GAS), improvement was seen in all tested areas. Researchers noted a 21% improvement on the CPRS and 14% on the CARS. Improvement was noted on the CGI-I scale, which showed that 36.4% of participants scored a one or two (one being "very much improved," two being ...