Risperidone in children and adolescents with autistic disorder and aggressive behaviour

Many patients with autistic disorder and learning disabilities show aggressive behaviour. This case series describes the use of risperidone in the treatment of four children/adolescents with autistic disorder who presented with severe and persistent symptoms of aggression and irritability that had remained treatment unresponsive. In addition, all patients had learning disabilities, one had Down's syndrome and three had epilepsy. Riperidone was initiated at 0.25mg or 0.5mg and titrated upwards slowly until maximum clinical benefit. Significant changes in social interaction, repetitive stereotype routines and aggressive behaviour were observed between a few days and up to four weeks after the start of treatment. The youngsters continue to improve on low maintenance doses of between 1-4mg a day. Treatment was well tolerated and although weight gain was seen in one patient none of them experienced extrapyramidal side effects. These case reports contribute to the emerging evidence that risperidone may be effective in ameliorating dysfunctional behaviours in children and adolescents with autistic disorder.