Academic journal article Journal of Early Childhood and Infant Psychology

Young Children with Developmental Disabilities and Atypical Antipsychotic Medications: Dual Diagnosis, Direction, and Debate

Academic journal article Journal of Early Childhood and Infant Psychology

Young Children with Developmental Disabilities and Atypical Antipsychotic Medications: Dual Diagnosis, Direction, and Debate

Article excerpt

Intensive early behavioral interventions are the treatment of choice for children with autism and many other developmental disabilities, as these children demonstrate symptoms such as aggression, hyperactivity/impulsivity, self-injurious behaviors, and irritability (Aman, Crisman, Francis, King, & Rojan, 2004). Providing effective treatments as early as possible is a primary goal of professionals working with children with developmental disabilities (Horner, Carr, Strain, Todd, & Reed, 2002). In keeping with this goal, physicians are increasingly prescribing atypical antipsychotic medications to children with autism and many other developmental disabilities (Dinca, Paul, & Spencer, 2005). However, the early prescription of psychotropic medications for children is controversial. This is especially so in the case of powerful medications such as atypical antipsychotic medications, which have significant and fairly common short-term side effects and unknown long-term effects.

Atypical antipsychotic medications are approved for use in older children and adolescents with bipolar disorder and early onset psychotic symptoms (Collins, 2008). One atypical antipsychotic (i.e., Risperdal) is also approved to treat irritability, aggression, and self-injurious behaviors in children ages 5 to 18 who have been diagnosed with autism (Chavez, Chavez-Brown, & Rey, 2006). Atypical antipsychotic medications are frequently prescribed off label (i.e., in a manner not approved by the US Food and Drug Administration [FDA]) for preschool aged children diagnosed with attention deficit hyperactivity disorder (ADHD), autism, bipolar disorder, early onset schizophrenia, intellectual disabilities, psychotic disorders, and other developmental disabilities (American Academy of Pediatrics Committee on Drugs, 1996; Antochi, Stavrakaki, & Emory, 2003; Findling & McNamara, 2004; Konstantinos, Fountoulakis, Nimatoudis, Iacovides, & Kaprins, 2004).

Although early administration of psychotropic medication may be as important as early behavioral interventions, administering medications in the effort to control the problem behaviors among young children points to special problems (Harris, 2008; Lilienfeld, 2005; Tyrer & Kendall, 2009). Among these issues or controversies are difficulties in making accurate diagnoses of mental health issues for young children, the increase in prescription practices, and the possible side effects of these medications. Indeed, the long-term effects in children younger than 5 years of age are unknown (Correll, 2008; Scahill, 2008). Given the potentially severe side effects of atypical antipsychotic medications (e.g., sedation, enuresis, seizures, decrease in white blood cells, constipation, dizziness, nausea, weight gain, excessive salivation), there is a tension between the need to implement earliest possible interventions and the vulnerability of young children to the potential side effects. In order to consider this issue, the physiological mechanisms of action, the evidence of effectiveness and side effects, and the medication debate are discussed.

Mechanisms of Action and Review of Evidence

Rationale

The general effectiveness and relative safety of atypical antipsychotic medication among adults with schizophrenia has recently caused many practitioners to begin prescribing these medications to children and adolescents (Findling, Steiner, & Weller, 2005). Despite the widespread popularity of these medications, surprisingly little research has been conducted regarding their efficacy, side effects, and mechanisms with children, especially young children (Aman et al., 2005; Harrison-Woolrych, Garcia-Quiroga, Ashton, & Herbison, 2007). In general, studies evaluating the use of atypical antipsychotics are lacking and the majority are confounded by methodological flaws (Aman & Madrid, 1999; Matson & Dempsey, 2008). A review of the existing literature suggests that although antipsychotic medications benefit children and adolescents with developmental disabilities and mental illness, careful consideration regarding their mechanism of action and effectiveness as compared to use among adults is crucial in the safe treatment of these individuals (Biederman et al. …

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