Risperidone Treatment in Preschool Children with Disruptive Behavior Disorders: A Chart Review Study

Objective: To gather data about the efficacy and safety of risperidone in normally developing preschool children with disruptive behavior disorders (DBDs). Methods: This is a retrospective chart review study of preschool aged children who were referred to a university hospital or a private child psychiatry clinic and treated with risperidone for the presence of DBDs. Charts of the subjects were reviewed for psychiatric characteristics of the subjects as well as the efficacy and safety of risperidone. Symptom severity and improvement were assessed with Clinical Global Impression- Severity (CGI-S) and Improvement (CGI-I) scales. Results: The subjects were 21 boys (84%) and 4 girls (16%) with an age range of 26-64 months (45.79 +/- 11). The duration of risperidone treatment ranged from 2-60 weeks (18.87 +/- 15.19). Risperidone dosage ranged from 0.25-1 mg/day (0.52 +/- 0.22 mg). Baseline and end point CGI-S scores ranged from 6-7(6.56 +/- 0.5) and 2-7 (3.96 +/- 1.3), respectively. A nonparametric Wilcoxon t-test revealed significant differences between baseline and end point CGI-S scores (p < 0.001). The majority of the subjects (n=18; 72%) showed "much" to "very much" improvement in target disruptive behavior symptoms. Overall five subjects (20%) did not report any side effects. The most frequently reported side effects were sedation, increased appetite, weight gain, enuresis, headache, dermatological reactions, and fatigue. Four subjects discontinued the medication due to side effects. Side effects were generally transient and mild to moderate in severity and no life threatening side effects were reported. Conclusions: Psychosocial interventions should be the first-line of treatment in preschool children with DBDs. Psychopharmacological treatment may be considered in severely impaired subjects with careful monitoring. Risperidone may generally be a safe and effective option in treating DBDs in preschool children; however, relatively high rates of side effects should suggest caution in the use of this drug. Further systematically designed studies are needed on this topic.