Aggression is a common behavioral issue in children with autism and similar developmental impairments. In addition to cognitive therapy, psychotropic drugs are often prescribed to manage anger, irritability, and aggressive outbursts. Risperdal (risperidone) is an atypical antipsychotic medication used successfully in the treatment of aggression. Several studies and years of clinical data have confirmed both the effectiveness and safety of Risperdal. As with any medication, matching patients to the appropriate drugs sometimes present a challenge. Recent research has looked at whether specific patient variables, known as moderators and mediators, might indicate when Risperdal is the preferred option.
Moderators and mediators are groups of patient variables that may have an impact on treatment effectiveness. Moderators are pre-existing circumstantial characteristics, such as level of education, socioeconomic class, or IQ score. Ideally, moderators function as predictors of treatment effectiveness and help guide doctors’ decisions. Mediators include all of the patient responses to medication, both behavioral and biological. Weight gain, changes in mineral balance and blood serum, and dose adherence all fall in the category of mediators. These variables come in to play after treatment begins.
In the specific case of autism and aggression, the only significant moderator for Risperdal is initial severity of aggression. Individuals with more severe aggression experienced more improvement than those with only mild or moderate aggressive tendencies. Potential moderators include parent education level, comorbid disorders, and socioeconomic conditions. However, no study has established a strong link between any of these variables and the outcome of Risperdal treatment. In terms of mediation, weight gain is the only variable proven to have an effect on outcome. Autistic children who gain weight above their developmental norms after beginning Risperdal show less symptom improvement. Researchers have theorized that poor responders to treatment often have their dosage increased, raising the probability of weight gain. Whether poor response to Risperdal or weight gain come first has yet to be determined.
When evaluating Risperdal for the treatment of aggression in autistic children, it’s important to consider both the severity of the aggression and the metabolic condition of the child. Severe cases of aggression stand to benefit more from Risperdal, thereby justifying potential adverse effects. After treatment commences, body mass and activity levels should be closely monitored, because excessive weight gain may negate the positive influence of the medication.
Arnold, L.E., Farmer, C., Kraemer, H.C., Davies, M., Witwer, A., Chuang, S., DiSilvestro, R., et al. (2010). Moderators, mediators, and other predictors of risperidone response in children with autistic disorder and disability. Journal of Child and Adolescent Psychopharmacology, 20, (2), 83-93.
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