On the use of risperidone and young children with autism

Without trying to scaremonger, it is already well known that certain anti-psychotics potentially indicated for some of the more 'challenging behaviours' associated with conditions like autism for example, carry their own important side-effects. Risperidone, one of the more commonly used medicines, has quite an extensive list of possible side-effects, some of which have been previously mentioned on this blog (see here). Increased appetite and weight gain are some of the more commonly observed side-effects.

The paper by Lawrence Scahill and colleagues [1] indeed concluded that weight gain and increased appetite also seemed to be present in their cohort of children with autism (mean age 6.9 years) who were in receipt of risperidone for approximately 30 weeks. Worryingly, the authors reported that there was an average of about 5 kg weight gain among 97 of their cohort with "risperidone exposure" and: "At baseline, 7 patients met conventional criteria for metabolic syndrome; by Week 16, 12 additional patients were so classified." The authors suggested that: "Rapid weight gain with risperidone treatment may promote the cascade of biochemical indices associated with insulin resistance and metabolic syndrome. Appetite, weight, waist circumference, liver function tests, blood lipids, and glucose warrant monitoring."

As per other posts on this blog, I'm not adverse to the selective use of medication to manage certain 'challenging behaviours' with autism in mind (see here) bearing in mind appropriate screening and 'detective work' before immediately reaching for such meds (see here). With appropriate medicines management and monitoring procedures in place, medicines such as antipsychotics (even with appropriate adjuvant therapy) can play an important role in managing symptoms and onwards positively affecting quality of life.

But it is important to note that there are risks attached to such medication use and the possible benefits to the presentation of certain behaviours have to be balanced with the those risks and specifically the potential role of side-effects. The additional important focus on children  - "mean age 6.9 + 2.35 years" - highlighted in the Scahill study also invites quite a lot more scrutiny. I know some people might be a little shocked that young children on the autism spectrum are being medicated in such a fashion, but other evidence has reported on the potential value of such an approach [2] particularly when quite extreme behaviours are present and are able to be so utterly disruptive. To tie in those findings on the presence of something like metabolic syndrome and the young age of medication recipients however, suggests that moves should continue (at a pace) towards the discovery of new methods and means of managing such behaviours without potentially setting recipients up for a lifetime of possible future health complaints.

Indeed, I'll be blogging about the related results from Chen et al [3] soon enough.

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[1] Scahill L. et al. Weight Gain and Metabolic Consequences of Risperidone in Young Children With Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2016. March 7.

[2] Fung LK. et al. Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis. Pediatrics. 2016 Feb;137 Suppl 2:S124-35.

[3] Chen MH. et al. Risk of Developing Type 2 Diabetes in Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Study. Diabetes Care. 2016 Mar 22. pii: dc151807.

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Scahill, L., Jeon, S., Boorin, S., McDougle, C., Aman, M., Dziura, J., McCracken, J., Caprio, S., Arnold, L., Nicol, G., Deng, Y., Challa, S., & Vitiello, B. (2016). Weight Gain and Metabolic Consequences of Risperidone in Young Children With Autism Spectrum Disorder Journal of the American Academy of Child & Adolescent Psychiatry DOI: 10.1016/j.jaac.2016.02.016