Atypical antipsychotic medications in the management of disruptive behaviors in children: safety guidelines and recommendations

Abstract

Use of atypical antipsychotic medications (AAMs) in the treatment of disruptive behavior (DB) in children and adolescents has increased dramatically worldwide. However, with exception of using risperidone (i.e., for the management of irritability associated with autism, manic and mixed episodes associated with bipolar I disorder, and schizophrenia) and aripiprazole (i.e., for manic and mixed episodes associated with bipolar I disorder and schizophrenia), the Food and Drug Administration (FDA) has not approved the use of AAMs in children and adolescents. Although research on use of these medications in children and adolescents has increased, mechanisms of action and long-term outcomes remain poorly understood or unknown. Particularly concerning is that use of these medications in children and adolescents may impact cognitive, social, and physical development, as side effects may interfere with activities in their educational setting, peer networks, and recreational settings. Overall, AAMs frequently are prescribed off label, control DB through sedation rather than targeting actual causes of DB, and lead to many negative side effects with unknown long-term effects. Reconsidering the use of AAMs in managing DB is encouraged strongly.