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Journal of Nursing

Risperdal and Autism 

Risperdal and Autism by Deda Donaldson, R.N. University of South Alabama College of Nursing [email protected]

Introduction


      Autism is developmental disorder in children and continues through adulthood. Currently, there is no known cause or cure for autism. Autism disorders range from mild symptoms, where the child seems “normal” but socially awkward, to severe symptoms, in which the child is non-verbal, and dependent on everyday care. Children with autistic disorders generally have difficulty with cognitive function, social interaction, and communication. Because of these social, cognitive, and communicative deficits, autistic children will often display behavior problems including aggression and irritability. The frustration builds, and the child does not know any other way to express himself. As with any medical condition, the earlier the diagnosis, the more effective the treatment is. Autism is no exception (Autism Research Institute, 2009).


Autism Treatment


      Treatment options have been and continue to be explored. In the past, treatment was aimed at behavior modification and life skills. No one single approach has worked, and the treatment is individualized. In October 2006, after many trials, the United States Food and Drug Administration (FDA) approved the use of the atypical antipsychotic, Risperdal (risperidone) for treatment of aggressive behavior in autistic patients ages 5-16 years old (United States Food and Drug Administration, 2006).


      As earlier stated, children with autism often display aggression and irritability. This is often caused by the frustration of not being able to express feelings or to communicate effectively. Fortunately, Risperdal is shown to help calm autistic individuals therefore enhancing communication as well as education ability. Autistic treatment now includes medical, social, and educational intervention (United States Food and Drug Administration, 2006).


      Individuals can be taught everyday life skills in education as well as behavior management. However, each autistic child is different, so each treatment plan should be individualized. Some autistic children have a severe deficit in cognitive and social skills, while others have very little problem at all. Hence, intervention must be approached on an individual basis (Autism Research Institute, 2009). 


Risperdal as a Treatment Option


      Since the FDA approved in October 2006, Risperdal is now prescribed as a treatment for aggressive, autistic children ages 5-16 years. Although the drug is not a cure, Risperdal helps in calming a frustrated, autistic child. Additionally, the medicine can prevent the child from becoming irritable and calm a hyperactive child, so he may learn or function in stressful situations. Risperdal may also help calm the child to prevent self injury or injury to others (United States Food and Drug Administration, 2006).


 In the past, antipsychotic or brain altering medications were used. These included antidepressants, stimulants, and anticonvulsants. The antipsychotic drug category has been studied the most for autism treatment. “Risperdal is the most-studied medication of its class in children” (Janssen, 2007). Risperdal is an atypical antipsychotic commonly prescribed for schizophrenia, but is now one of the choice drugs in this category being used for aggression, hyperactivity, and irritability associated with autism (Drugs.com, 2008).   
 


Patient Prescribing and Safety Information


      Risperdal is available in 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, and 4 mg tablets. Risperdal is also available as an oral disintegrating tablet, Risperdal M-Tab, in 0.5 mg, 1 mg, 2 mg, 3 mg, and 4 mg doses, and an oral solution in 1.0 mg/mL. Dosing is calculated according to patient’s weight. For less than 20kg, the patient is given a starting dose of 0.25mg/day for four days. Dosage is then increased to a target dose of 0.5mg/day for fourteen days. For patients weighing 20kg or more, a starting dose of 0.5mg for 4 days is used, and later increased to 1.0mg/day for 14 days. After the target dose has been maintained for at least 14 days, additional doses maybe considered if indicated (Janssen, 2008).


      The side effects reported while taking Risperdal include dizziness, drowsiness, dry mouth, blurred vision, constipation, weight gain, and headache. Adverse effects include arrhythmias, hypotension, pulmonary embolism, cardiopulmonary arrest, and angioedema. Life threatening effects associated with taking Risperdal include tardive dyskinesia, hyperprolactinemia, seizures, hyperglycemia, suicide, and neuroleptic malignant syndrome. Certain medications taken with Risperdal cause problems as well (Rxlist.com, 2009).


Patient Education


      As with all other medications, Risperdal does have side effects as well as a few potentially fatal effects that should be explained to patient at the time the prescription is given. This enhances patient compliance as well as safety. Common side effects as well as adverse effects were previously listed. Parents and patients should be educated on what symptoms necessitate an emergency, calling the doctor, or discontinuing the use of Risperdal. Although some side effects are inevitable, some symptoms warrant life threatening emergencies. The doctor should also review any medications the patient is taking that may cause any kind of interactions with Risperdal (Janssen, n.d.).


Conclusion


      Autism is a mysterious mental illness without a cure or successful treatment. Until recently, medications or treatments were not known to help with autism.  Through much research, autism treatment includes behavior modification and education combined with medication. After a group study was done and showed success, Risperdal was FDA approved for symptoms often displayed by autistic children. The medication helped calm the child resulting in resolving temper tantrums, aggression to self and others, and frustration (United States Food and Drug Administration, 2006)


      Risperdal, although not a cure, can help autistic children. When prescribed, dosing is calculated according to patient’s weight. For less than 20kg, the patient is given a starting dose of 0.25mg/day for four days.  Dosage is then increased to a target dose of 0.5mg/day for fourteen days. The same is true for patients weighing 20kg or more with a starting dose of 0.5mg for 4 days and increased to 1.0mg/day for 14 days. After the target dose has been maintained for at least 14 days, additional doses maybe considered (Janssen, 2008).


      Parents and patients need to be educated about Risperdal side effects and when or if the medication should be stopped. Tardive dyskinesia, hyperprolactinemia, hyperglycemia, and Neuroleptic Malignant Syndrome are potentially fatal effects that have been associated while taking Risperdal (Drugs.com, 2008).   
 
 


References


Autism Research Institute. (2009). What is autism? Retrieved Feb. 11, 2009, fromhttp://www.autism.com/autism/index.htm.


Drugs.com. (2008). Consumer information risperdal. Retrieved Feb. 12, 2009, fromhttp://www.drugs.com/risperdal.html


Janssen. (2007). Risperdal-autism. Retrieved Feb.12, 2009, from      http://www.janssen.com/janssen/products_risperdal-autism.html


Janssen. (n.d.). Risperdal. Highlights of prescribing information. Retrieved Feb.12,2009, from http://www.risperdalautism.com/risperdalautism/shared/pi/risperdal.pdf#zoom=100


Rxlist.com. (2009). Risperdal indications & dosage. Retrieved Feb. 28, 2009, fromhttp://www.rxlist.com/risperdal-drug.htm


      United States Food and Drug Administration. (October 2006). FDA approves the first drug to treat irritability associated with autism, risperdal. Retrieved Feb.12, 2009, from   http://www.fda.gov/bbs/topics/news/2006/new01485.html


United States Food and Drug Administration. (November 2008). One year post-exclusivity adverse event review: risperidone. Retrieved Feb.12, 2009, from http://www.fda.gov/ohrms/dockets/ac/08/slides/2008-4399s1-04%20(Risperidone).pdf





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