In this post I will share some of the research about an anti-psychotic medication called Risperdal. I will also share our personal experience in treating our son with this medication. In my previous post I had discussed the process of making the decision to medicate your child.
For any parent who must make this decision, it is not an easy one. There are numerous factors which go into choosing whether or not to medicate your child and I would strongly encourage parents to read my article for some helpful guidelines to make the process easier.
A little disclaimer
I am going to preface my story by listing a few disclaimers. I am not advocating the use of medication for any child. I am not advocating the use of Risperidone. Any medication you use to treat the symptoms of ADHD or any co-existing or co-morbid disorders such as autism, Bipolar Disorder , Oppositional Defiance Disorder, Intermittent Explosive Disorder and so forth, will have side effects. As a parent you need to do your homework and research the particular medication you are thinking of giving your child. Medicating your child is a very personal decision and a very serious one. Our experience with Risperidone is but one case. What works for my son may not work for your child. I hope that by sharing this story, that you will feel more at ease talking about your own experiences here on ADHD Central.
The Research on Risperidone
Risperidone is an anti-psychotic medication. It has been used to treat the symptoms of schizophrenia and bipolar mania. In addition, Risperidone is currently the only drug the FDA has approved for use in the treatment of children with autism. There have been many studies which show the efficacy of using Risperdal for children with autism and serious behavior problems. For example, this 2002 study published in the New England Journal of Medicine, concluded that: "Risperidone was effective and well tolerated for the treatment of tantrums, aggression, or self-injurious behavior in children with autistic disorder." The National Institutes of Mental Health also state that: "Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5-16 years of age who have autism."
There are also studies which show that Risperidone has been used with some success in the treatment of children with ADHD and especially those with certain co-morbid conditions. In a 2004 study published in the Journal of Child and Adolescent Psychopharmacology, researchers found that: "Risperidone was a safe and effective treatment, with or without a combined psychostimulant, for both disruptive behavior disorders and comorbid ADHD in children." This finding is consistent with a 2008 scientific review, Pharmacological Treatment of Pathologic Aggression in Children, published in the International Review of Psychiatry. The authors concluded that Risperdal has the most evidence of all the available medications for the safe and efficacious treatment of pathologic aggression in children who are between the ages of 5-17. It has been shown to decrease aggression, disruptive behaviors, and hyperactivity.
As with any medication there are studies which demonstrate that the drug is safe and effective. Then there are warnings which highlight the dangers of side effects. There may also be research to show that the drug is not as effective as other studies show such as this 2008 study which concluded that Risperdal was as effective as a sugar pill in decreasing aggressive behavior in some patients. As a parent, it is wise to read all the research and warnings so that you can have an informed and balanced view. Risperdal has some potentially very serious side effects. The official Risperdal site lists Neuroleptic Malignant Syndrome (NMS), a rare and potentially fatal side effect reported with Risperdal. If you decide to use Risperdal for your child, make sure to talk to your child's doctor about all the potential risks and what to look for as far as dangerous side effects.
I hope you have stayed with me so far in reading this post. I understand that reading the research about medications can be tedious but it is essential in making that decision as to what medication is best for your child. What led us to try Risperdal was a recommendation from our son's pediatric neurologist. My son has a diagnosis of autism and he also has symptoms of ADHD. In the past we have used a small dose of Prozac (10 mg) to help my son with some mood issues such as tearfulness and irritability. It was effective for a couple of years. But shortly after my son's 14th birthday all of that changed. My usually mild-mannered son became more and more aggressive, ritualistic, and prone to emotional meltdowns where nothing seemed to calm him.
Nothing had changed in his environment except adolescence. We had exhausted all the behavior management, sensory integration, and dietary strategies. Whatever we were dealing with was biological in nature. These were no ordinary behavior problems. His aggressive outbursts were interfering with every aspect of his day from learning to sleep. My son would sometimes wake up in the middle of the night and become agitated to the point of total loss of control. It was frightening for us and it was frightening for him. One day he asked to go to the doctor. He understood he needed help.
We tried a medication called Clonidine at first. Clonidine is a blood pressure medication which is used off label to treat impulsive, defiant, and aggressive behaviors in children with ADHD or autism. It is also used by some to treat the side effects of stimulant medications such as difficulty with sleeping. This medication was highly ineffective for my son. The most it did was cause him to nap multiple times a day. When he woke up he was more agitated than ever. I was also not comfortable with it being an off label medication and the fact that it would affect my son's blood pressure. We returned to the neurologist who got to see first-hand how this medication was not working for my son.
After dealing with my son's extreme behavior changes for nearly a year, we made the decision to go with the big guns, an anti-psychotic medication. If you had told me we would be doing this even several years ago I would have never thought it possible. I am not anti-medication but I have always been extremely cautious about medications in general. There are always side effects and risks with any medication and especially with an anti-psychotic. I know some about this as my mother has schizophrenia. Drug treatment for her has been primarily unsuccessful. So this was one of the most emotionally wrenching decisions I have ever had to make. Yet if there was any hope that medication treatment could help, I wanted to give my son that chance.
My son's doctor told us we would see the benefits of Risperdal fairly quickly. She was right. In a few days my son's aggression had decreased so drastically that the log book we usually write pages in to describe aggressive, disruptive, and self injurious behavior was nearly empty. It was that dramatic for my son. We noticed an increase in communication and wanting to tell us things. His hyperactivity has also decreased significantly. He has been able to focus and is asking to do his lessons. He is sleeping through the night. We are able to go to most any place in the community without a fight. He is patient when waiting in lines. He is smiling, happy, and creative. Most of all I see a boy now who is enjoying his life. This is the best I could have hoped for.
We were warned about the side effects. Mainly the big one people report is about the weight gain. I have heard stories of weight gain of up to fifty pounds when a child uses Risperdal. My son was underweight to begin with due to his hyperactivity and the Prozac. Now he is at a healthy weight. I like his increased appetite. We have healthy foods at the ready such as cut up veggies or gluten free snacks. His eating habits have not been a problem for us. He does have increased saliva production and he is thirsty due to the side effect of dry mouth. He has experienced some night time bed wetting but this has mostly been cured by simply reminding him to use the bathroom before bed. He does nap more, usually once in the afternoon after his lessons are finished. His sleep is wonderful and he gets a good restful and uninterrupted sleep.
Risperdal is not a cure for all my son's behaviors. We still have breakthrough moments and especially in the morning for about an hour to two hours after we give him his morning dosage. My son still exhibits silly attention getting behaviors but the incidence of aggression has, for the most part, decreased by about 80% or more. We now have more time as a family to have fun and get things done instead of constantly having to deal with my son's behavior problems.
Medication is not a panacea. It cannot cure autism or ADHD. But sometimes, if it is the right medication at the right dosage, it can really help. I am personally grateful that we have such treatment options.
If you have any questions about our experience just ask. We would like to encourage all of our members, whether you are a parent or an individual who has ADHD or a related condition to talk about your experiences with medication treatment. Your story may help others who are going through the same thing.