MSc (Med) (Child Health Neurodevelopment), Faculty of Health Sciences, University of the Witwatersrand / Background
Disruptive behaviour is the most commonly reported mental health problem in individuals with learning disability. Pharmacotherapy is part of a multidisciplinary approach to the treatment of disruptive behaviour. Risperidone, an atypical antipsychotic drug, is the most commonly used treatment for symptom improvement. It is therefore important to establish the efficacy and safety of risperidone therapy in this dependent, vulnerable and young population, given the well documented adverse effects and the potential for long term treatment.
Objectives
To assess the effects of risperidone for disruptive behaviour in children and adolescents with learning disability.
Search strategy
The following electronic databases were searched: CENTRAL (Cochrane Central Register of Controlled Trials); MEDLINE; PsycINFO; CINAHL; Clinicaltrials.gov; National Research Register (NRR). In addition, reference lists of relevant publications and narrative reviews were checked; handsearches were done; authors of published trials and pharmaceutical manufacturer of risperidone (Risperdal) were contacted.
Selection criteria
All randomised or quasi-randomised controlled trials of risperidone versus placebo (or no treatment) for children and adolescents (age less than 18 years) with a diagnosis of learning disability and disruptive behaviour were considered.
Data collection and analysis
Trial eligibility and data quality were evaluated and analysed by the author and independently verified by an additional reviewer. Unpublished data were considered for inclusion and relevant authors were contacted in the case of incomplete data.
Results
Four randomised controlled trials involving 279 children and adolescents were identified. The majority of the children were living at home and not institutionalised. Meta-analyses of the primary outcome scales (Nisonger Child Behaviour Rating Form, Aberrant Behaviour Checklist, Behaviour Problem Inventory) measuring several core symptoms of disruptive behaviour, namely conduct problems, self-injury, irritability, aggressive / destructive behaviours and stereotypy suggest statistically significant improvement in disruptive type behaviours in children treated with risperidone compared to placebo. Adverse event data showed that the prevalence of adverse effects viz. weight gain, sedation / somnolence and raised prolactin levels were significantly higher in the children receiving risperidone.
Conclusions
In the studies included in this review, risperidone treatment for disruptive behaviour in learning disabled children and adolescents appears to have a beneficial effect on certain symptoms of disruptive behaviour. However, the applicability of these findings to wider clinical practice remains unclear, due to poor methodological quality, inadequate study sample size and short duration of treatment of the included studies. Long term safety has not been established and serious adverse effects, affecting growth, are of concern. Further research is required to establish the efficacy and safety of risperidone for disruptive behaviour in learning disabled children and adolescents in clinical practice.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/8839 |
| Date | 21 October 2010 |
| Creators | Bezuidenhout, Heidre |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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