Antipsychotics May Offer Short-Term Benefits to Some Children
Abstract
A meta-analysis suggests that children with intellectual disabilities who display aggression may benefit from short-term use of antipsychotics, but little is known of the long-term effects of the medication.
Children with intellectual disabilities who display aggression and other challenging behaviors may benefit from short-term use of antipsychotics, but long-term evidence of the effectiveness of these medications is lacking, according to a meta-analysis published last month in BMC Psychiatry.
People with intellectual disability who display aggression toward others and the environment, self-injury, and difficulty at integrating into the community can create challenges for the people who care for them. Although a variety of psychosocial interventions have been used to manage challenging behaviors in this population, medications are often used in addition to or in place of therapy.
To determine the safety and effectiveness of such pharmacologic interventions, Cheryl McQuire, a Ph.D. candidate at Cardiff University in Cardiff, Wales, and colleagues recently reviewed electronic databases, reference lists, and trial registries. They identified 14 studies—including randomized, controlled trials comparing the effectiveness of antipsychotics, anticonvulsants, antioxidants, and gamma-aminobutyric acid (GABA) analogues in 912 children and adolescents under 18 with intellectual disabilities and challenging behavior. Intellectual disabilities were defined by an intelligence test score of less than 70 and/or significant impairment of social or adaptive functioning, with childhood onset.
McQuire and her colleagues used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of evidence for the outcome of each study. This approach considers factors including risk of bias, inconsistency, indirectness, imprecision, and publication bias. The researchers also evaluated each study for evidence of safety and effectiveness of outcome.
“Antipsychotic medications appear to be effective for reducing challenging behavior in the short term among children with intellectual disabilities, but they carry a risk of significant side effects,” including significant weight gain, increased prolactin levels, and sedation, the researchers concluded. What was less clear, the researchers noted, was the long-term effectiveness of the medications.
“The meta-analysis makes it clear that the evidence is still lacking, and we need further studies of pharmacological interventions alone or in combination with psychosocial approaches that we hope to pursue in the future,” study coauthor Angela Hassiotis, Ph.D., told Psychiatric News. Hassiotis is a professor in the Division of Psychiatry at University College London. She expressed the research team’s additional concern that “many of the papers do not mention specifically what other treatments the children may have received or are receiving as part even of standard care.”
“There is a lot of interest internationally on the topic of medications in people with intellectual disabilities across the age span, and often views about what is appropriate treatment can be polarized,” said Hassiotis. “Some evidence, particularly in children with autism and challenging behavior, suggests that certain antipsychotics may be helpful, but we should not forget the side effects that may accrue as a consequence.”
The research was supported by the National Institute for Health and Care Excellence. ■
