Abstract
BackgroundPsychotropic medications are frequently used to treat challenging behaviour in children with intellectual disabilities, despite a lack of evidence for their efficacy. This systematic review and meta-analysis aimed to determine the safety and efficacy of pharmacological interventions for challenging behaviour among children with intellectual disabilities.MethodsElectronic databases were searched and supplemented with a hand search of reference lists and trial registries. Randomised controlled trials of pharmacological interventions for challenging behaviour among children with intellectual disabilities were included. Data were analysed using meta-analysis or described narratively if meta-analysis was not possible. For quality assessment, the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used.ResultsFourteen studies including 912 participants met inclusion criteria. Antipsychotic medication reduced challenging behaviour among children with intellectual disabilities in the short-term (SMD = −1.09, p < 0.001 for risperidone; SMD = −0.64, p <0.001 for aripiprazole). However, there were significant side-effects including elevated prolactin levels (SMD = 3.22, p < 0.001) and weight gain (SMD = 0.82, p < 0.001). Evidence was inconclusive regarding the effectiveness of anticonvulsants and antioxidants for reducing challenging behaviour. The quality of all evidence was low and there were no long term follow up studies.ConclusionsAntipsychotic medications appear to be effective for reducing challenging behaviour in the short-term among children with intellectual disabilities, but they carry a risk of significant side effects. Findings from this review must be interpreted with caution as studies were typically of low quality and most outcomes were based on a small number of studies. Further long-term, high-quality research is needed to determine the effectiveness and safety of psychotropic medication for reducing challenging behaviour.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0688-2) contains supplementary material, which is available to authorized users.
Highlights
Psychotropic medications are frequently used to treat challenging behaviour in children with intellectual disabilities, despite a lack of evidence for their efficacy
Anticonvulsants were evaluated in three studies [39, 40, 47], antioxidants in one study [38] and gamma-aminobutyric acid (GABA) analogues in one study [36]
This review demonstrates that antipsychotic medication was associated with a range of side effects among children including significant weight gain, Fig. 7 The effect of valproate and topiramate on weight in children with intellectual disabilities and challenging behaviour
Summary
Psychotropic medications are frequently used to treat challenging behaviour in children with intellectual disabilities, despite a lack of evidence for their efficacy. A common problem in this population is challenging behaviour, which presents as episodic aggression towards others and the environment, self-injury, and a host of other behaviours that may be seen as socially unacceptable and prevent the individual from fully participating in day to day life [5]. The prevalence of such problems is lower in the community than in hospital or congregate settings but rates vary according to features of study design, such as how challenging behaviour is measured [6]. Staff caring for individuals with IDD and challenging behaviour may report burnout and low job satisfaction [10, 11]
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