This week on Family Anatomy, we’ll be focusing on treatments for autism. Using anti-psychotic medications when there is no psychosis is considered “off-label” use. That is, physicians can prescribe it even though it has not been specifically studied and proved to be effective with a particular group of people. As a psychologist working with school-aged children, I have noticed the increasing use of off-label anti-psychotic medications for kids with severe aggressive behaviour. A small percentage of these kids are autistic.
Research reported in an August 2002 issue of the New England Journal of Medicine looked specifically at whether risperidone, a so-called “atypical antipsychotic” that is widely used to address aggressive behaviour in children, had a beneficial effect when given to autistic kids. Dr. McCracken and his colleagues studied 101 kids ages 5 to 17 with serious behavioural disturbances such as self-injurious behaviour, aggression and tantrums in response to routine demands. They assigned 52 kids to a placebo group, while the remaining 49 received risperidone therapy. What they found was that autistic kids on risperidone had almost a 57% reduction in their level of irritability, as compared to only 14% in the control group. The study showed that a significant reduction in irritability could be expected by using this drug. They also found that in two-thirds of the kids who responded well to risperidone, the positive effects were maintained six months later. At the same time, in the four months within which the study was conducted, the researchers found that increased appetite, fatigue, drowsiness, dizziness, and drooling were more common in the risperidone group than in the placebo group.
One could easily argue that, compared to the difficulty of dealing with serious aggressive behaviour, these side-effects, while unfortunate, should not prevent a physician or parent from deciding to go forward with risperidone treatment. However, the researchers do note that, given the short length of the treatment, adverse side effects such as tardive dyskinesia, could not be evaluated. Tardive dyskinesia is a neurological disease brought about by long-term or intensive use of anti-psychotic medications. It manifests as repetitive, involuntary, purposeless movements typically seen on a persons’ face as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and/or rapid eye blinking. Psychiatrist Peter Breggin has been an advocate against the over-prescribing of anti-psychotic medications and recently wrote an article in the Huffington Post about the dangers of these medications and how concerned he is with the fact that the FDA has recently begun approving these drugs for use in children.
Dr. Breggin notes that newer anti-psychotics such as risperidone are only marginally better than some of the older drugs that resulted in 15% of patients suffering from life long tardive dyskinesia. He argues that, in children, the long-term effects of prolonged use of risperidone are likely to cause tardive dyskinesia in a certain percentage of kids. The question is not going to be if kids will end up with tardive dyskinesia, but rather what percentage of kids are likely to be effected in this way. In addition to this, Dr. Breggin states that newer antipsychotics frequently cause diabetes and pancreatitis in children. To emphasize his point, he reports that drug manufacturer Eli Lilly paid over a billion dollars to settle hundreds of diabetes cases related to Zyprexa, another one of the atypical anti-psychotics.
Parents are typically not informed of the more serious side effects of these drugs. This clearly needs to change. It is important for parents to be aware that, in a minority of cases, serious consequences are likely to result with prolonged use of these drugs. On the other hand, parents of autistic kids may still feel, that given the frequency and intensity of aggressive behaviour in their child, they have little choice but to consider at least short term treatment with these drugs. The question is not whether these drugs are effective in reducing aggressive behaviour in kids. In a majority of cases, risperidone works as advertised. The question that parents need to ask themselves is, can they live with the potential costs of long-term exposure?
You can read the New England Journal of Medicine article here.
Note: Posts on Family Anatomy are for education only. If you need to talk to someone about family or mental health issues, you can get a referral from your family doctor.