Case Study III: A Closer Look
What would you recommend following the mother’s inquiry into risperidone?
To put a child with ASD on a pharmacologic medication that specifically targets maladaptive behaviors is a big decision for parents. It requires a physician who is familiar with the therapeutic and adverse effects of the medication, committed to monitoring the child regularly, and comfortable counseling the parents while the child is on medication.
Any conversation with parents who are considering medication for a child with ASD should include the following statement: Medications can alleviate some of the associated symptoms of ASD, but they do not treat the core symptoms (i.e., qualitative impairment of social interaction, qualitative impairment of communication, and restricted and repetitive behaviors).
- Associated symptoms of ASD potentially helped by pharmacologic medications include aggression, self-injury, oppositionality, hyperactivity, impulsivity, inattention, irritability, emotional lability, depression, anxiety, unusual responses to sensory stimuli, irregular appetite, sleep problems, and gastrointestinal disturbances.
Emphasize to parents that the most studied and effective of ASD treatments are behavioral management and sustained, intensive educational interventions. There are certainly limitations to these treatments: they take time to see incremental benefits, they are labor-intensive and expensive, and they are difficult to take to scale.
Pharmacologic medications are appealing because effects can be seen almost immediately. Kofi demonstrates several associated symptoms that have not improved with behavioral intervention. It appears they are severely interfering in multiple settings and potentially harmful. A serious discussion about medication as an adjunct treatment is appropriate.
Risperidone is an FDA-approved atypical antipsychotic medication used for the treatment of behavioral problems in children aged 5 to 17 years with ASD. These behaviors include irritability described as tantrums, aggression, and self-injurious behavior.
- Side effects of risperidone include weight gain and increased appetite, sedation, constipation, and fatigue. There can also be effects such as prolactinemia, insulin resistance, elevated lipids, movement disorders (e.g. tremors), seizures, and dry mouth.
Health monitoring of children on risperidone includes a baseline exam measuring BMI as well as lab testing including
- lipid profile,
- liver function tests,
- and fasting glucose (blood sugar) or HBA1C.
This testing should be repeated at regular intervals. Clinical trials have confirmed that risperidone is a useful medication for the short-term treatment of irritability associated with ASD.