Intense tantrums, aggression, and self-injury are some of the most worrying symptoms associated with autism. These behaviors are usually addressed with therapy, but doctors may decide that medication is needed.
Risperidone is an antipsychotic sometimes prescribed to children with autism spectrum disorder (ASD). Let’s explore what this drug does and whether it’s effective for kids on the spectrum.
What is risperidone?
Risperidone is part of a class of drugs called “atypical antipsychotics” or “second-generation antipsychotics” (SGAs). The first-generation antipsychotics were introduced in the 1950s but had severe side effects, so a second generation was developed to replace them.
First-generation antipsychotics are still used to treat severe behavioral symptoms that don’t respond to other methods.
Risperidone was developed by Johnson & Johnson in the early 1990s and sold under the brand name Risperdal. It’s also available in generic form.
What does risperidone treat?
This substance is FDA-approved to treat adults and teenagers with schizophrenia or bipolar disorder, as well as children with autism who are 5-16 years old. In particular, Risperdal is supposed to manage aggression, mood swings, irritability, and self-harm in autistic patients.
In 2006, Risperdal became the first drug to be FDA-approved for autism, as well as the first SGA approved for children and adolescents.
Doctors also occasionally prescribe risperidone for non-FDA-approved uses, like attention deficit hyperactivity disorder (ADHD), depression, Tourette’s syndrome, and various mental health conditions.
What does risperidone do to the brain?
The ingredients in Risperdal work to block dopamine and serotonin. These are neurotransmitters, which transport signals across the brain. Higher levels of dopamine and/or serotonin are associated with happier moods, but overproduction of dopamine is thought to cause psychotic, manic, or aggressive behavior. Serotonin receptors also play a key role in schizophrenia.
By blocking these neurotransmitters, medical professionals state risperidone restores balance to the brain and decreases the symptoms.
Is risperidone recommended for children with autism?
Autism research has shown that risperidone may be an effective treatment for children and adolescents on the spectrum.
McCracken et al. (2002) studied how well the drug worked compared to a placebo. Placebos are substances that have no effect but are randomly assigned to subjects during clinical trials to test the other substance’s success. This is so researchers can rule out whether the patients feel better because of the drug itself, or because taking any “drug” has tricked them into thinking they’re feeling better.
McCracken et al. tested 101 autistic children ages 5-17, with half receiving risperidone and half receiving a placebo. Within eight weeks of treatment, 69% of the risperidone group showed a decrease in irritability, compared to 12% of the placebo group. Two-thirds of the children who had a positive response to risperidone continued to show improvement six months later.
A 2005 randomized clinical trial by the Pediatric Psychopharmacology Autism Network also found that the drug decreased aggressive behavior in children with autism, but the symptoms soon returned if treatment ended.
Overall, risperidone achieves results for many autistic children and adolescents. It’s not a cure for autism spectrum disorders, but it can help manage irritability, tantrums, aggression, and self-injury.
How is Risperdal taken?
This drug is available in normal tablets, orally-disintegrating tablets, or as a liquid. Doctors typically start children with autism out on a low dose, then gradually increase the dosage to allow the body to adjust. Risperdal is taken once or twice a day, with or without food.
Orally-disintegrating tablets dissolve quickly in the mouth and shouldn’t be chewed or crushed. The liquid form can be taken directly or mixed into another drink like juice or milk. The Food and Drug Administration (FDA) doesn’t recommend mixing it with tea or soda.
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Risperdal Consta is an injectable form of the drug, though it’s usually only used for people with schizophrenia or bipolar disorder. Injections should only be given by a medical professional every two weeks.
It’s important to follow your healthcare provider’s instructions when it comes to taking risperidone or any other drug.
The United States National Library of Medicine lists several side effects to Risperidone, including:
- Nausea and vomiting
- Stomach pain
- Increased appetite
- Weight gain
- Muscle or joint pain
- Involuntary muscle movements
- Dry mouth
Weight gain and increased appetite are some of the more common side effects seen with risperidone in children. The patients treated with risperidone in McCracken et al. had a higher average weight gain (5-6 pounds) than those who didn’t. About half of the children taking risperidone also had mild fatigue, though it usually went away by the end of the clinical trial. That group was also more likely to have tremors than the placebo group.
The 2005 study, which had the treatment last for six months, observed an even higher average weight gain of 11 pounds. Some children also showed drowsiness and fatigue. However, only one child withdrew from the study because of side effects.
Another concerning side effect is tardive dyskinesia, a condition that causes involuntary movements like grimacing, blinking, limping, and more. It can be caused by several antipsychotics; risperidone produces it less often than others, but it has happened.
Most cases involve elderly patients, but there’s at least one reported instance of a 13-year-old boy with autism displaying jerky movements after his dose of risperidone was increased (Kidd 2018). When his parents noticed the symptoms, his dose was lowered until he was taken off the drug entirely, and the adverse symptoms disappeared.
This condition may be irreversible, so antipsychotic patients should notify their doctor as soon as possible.
Increased prolactin levels
Risperdal has also been associated with an increase in prolactin, a hormone whose main role is to produce breast milk. Higher prolactin levels can result in nipple discharge, breast enlargement, and gynecomastia (the growth of breast tissue in boys and men). Several thousand lawsuits have been filed against Johnson & Johnson by boys who developed gynecomastia after taking Risperdal.
Other antipsychotics for autism
As of now, risperidone and aripiprazole are the only substances approved to treat autism by the Food and Drug administration. Both target irritability.
Aripiprazole is a different treatment, commonly marketed as Abilify, which was approved in 2009. Like Risperdal, it’s an SGA also used for people with schizophrenia or bipolar.
Initial research suggested that Abilify may be safer for children with autism, but recent coverage by Spectrum News found that it was just as likely to cause weight gain and other side effects.
Other atypical antipsychotics—such as olanzapine, ziprasidone, and quetiapine—have been tested for safety and efficacy in kids with autism, but risperidone and aripiprazole continue to be the most effective with the least adverse effects.
Self-injury and aggression are worrying for any parent. You want your children to be happy and healthy, but it can be hard to know which therapy, treatment, or drug is the right choice.
Children taking Risperdal often face side effects, especially weight gain. Some parents may decide that this is worth it in exchange for calmer behavior. At the end of the day, every child and adolescent is different. One may respond well to a certain substance or dose, while another won’t, so finding the right fit often takes trial and error.
You should always discuss your options with a medical professional before making a decision. They will be able to help you decide how to manage your child’s behavior, as well as monitor them during treatment.
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GoodTherapy. (n.d.). Typical and Atypical Antipsychotic Agents. GoodTherapy. https://www.goodtherapy.org/drugs/anti-psychotics.html
Kidd, V. (2018). Risperidone-Induced Tardive Dyskinesia in an Autistic Child. Psychiatrist.com. https://www.psychiatrist.com/pcc/movement-disorder/risperidone-induced-tardive-dyskinesia-in-an-autistic-child/
McCracken, J. T. (2002, August 1). Risperidone in Children with Autism and Serious Behavioral Problems List of authors. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/nejmoa013171
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Posey, D. J. (2008, January 2). Antipsychotics in the treatment of autism. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2171144/
Research Units on Pediatric Psychopharmacology Autism Network. (2005). Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months. CORE. https://core.ac.uk/reader/159570178?utm_source=linkout