Cochrane for Clinicians

Putting Evidence into Practice

Atypical Antipsychotics for Disruptive Behavior Disorders in Children and Adolescents

 

Am Fam Physician. 2018 Jun 1;97(11):715-716.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does the atypical antipsychotic risperidone (Risperdal) safely and effectively treat disruptive behavior disorders in children and adolescents?

Evidence-Based Answer

Risperidone reduces measures of aggression and improves conduct in children with disruptive behavior disorders; however, only short-term use is recommended. Weight gain of 2 to 2.5 kg (4.4 to 5.5 lb) is common. There is insufficient evidence to evaluate the benefits of other antipsychotics.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Disruptive behavior disorders in children and adolescents include conduct disorder and oppositional defiant disorder. These disorders are common, affecting 5.7% of children.2 The authors of this Cochrane review sought to demonstrate whether atypical antipsychotics safely and effectively reduce aggression and improve conduct in children and adolescents with these disorders.1

The review included 10 trials and 896 patients five to 18 years of age. Follow-up ranged from four to 10 weeks. Risperidone was evaluated in eight of the 10 trials1  (Table 1).

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TABLE 1.

Comparison of Risperidone and Placebo for Disruptive Behavior Disorder in Children and Adolescents

Significant outcomesDifference between risperidone (Risperdal) and placebo groupsStudiesParticipantsQuality of evidence

Aggression (Aberrant Behavior Checklist–Irritability subscale; reference range = 0 to 45)

MD = 6.49 points lower with risperidone

3

238

Low

Aggression (Modified Overt Aggression Scale combined with Antisocial Behavior Scale–Reactive subscale)

Standardized MD = 1.30 (favoring risperidone)

2

190

Moderate

Conduct (Nisonger Child Behavior Rating Form–Conduct Problem subscale; reference range = 0 to 48)

MD = 8.61 points lower with risperidone

2

225

Moderate

Weight gain (antipsychotic alone)

MD = 2.37 kg (5.22 lb) more with risperidone

2

138

Moderate

Weight gain (stimulant plus antipsychotic)

MD = 2.14 kg (4.72 lb) more with risperidone

3

305

Low


MD = mean difference.

TABLE 1.

Comparison of Risperidone and Placebo for Disruptive Behavior Disorder in Children and Adolescents

Significant outcomesDifference between risperidone (Risperdal) and placebo groupsStudiesParticipantsQuality of evidence

Aggression (Aberrant Behavior Checklist–Irritability subscale; reference range = 0 to 45)

MD = 6.49 points lower with risperidone

3

238

Low

Aggression (Modified Overt Aggression Scale combined with Antisocial Behavior Scale–Reactive subscale)

Standardized MD = 1.30 (favoring risperidone)

2

190

Moderate

Conduct (Nisonger Child Behavior Rating Form–Conduct Problem subscale; reference range = 0 to 48)

MD = 8.61 points lower with risperidone

2

225

Moderate

Weight gain (antipsychotic alone)

MD = 2.37 kg (5.22 lb) more with risperidone

2

138

Moderate

Weight gain (stimulant plus antipsychotic)

MD = 2.14 kg (4.72 lb) more with risperidone

3

305

Low


MD = mean difference.

Three trials using risperidone measured aggression with the Aberrant Behavior Checklist–Irritability subscale (reference range: 0 to 45). Patients taking risperidone scored, on average, 6.49 points lower than those taking placebo (95% confidence interval [CI], −8.79 to −4.19). One risperidone trial used the Modified Overt Aggression Scale, whereas another used the two-part Antisocial Behavior Scale. Both parts of the Antisocial Behavior Scale were analyzed separately with the trial that used

Author disclosure: No relevant financial affiliations.

References

show all references

1. Loy JH, Merry SN, Hetrick SE, Stasiak K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst Rev. 2017;(8):CD008559....

2. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–365.

3. Aman MG, Binder C, Turgay A. Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. J Child Adolesc Psychopharmacol. 2004;14(2):243–254.

4. National Collaborating Centre for Mental Health; Social Care Institute for Excellence. Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management. NICE clinical guideline no. 158. Leicester, United Kingdom: British Psychological Society for the National Institute for Health and Care Excellence (NICE); 2013.

5. Gorman DA, Gardner DM, Murphy AL, et al. Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder. Can J Psychiatry. 2015;60(2):62–76.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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