No Data Supporting Risperidone for Children With Intellectual Disabilities, ADHD

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Title: No Data Supporting Risperidone for Children With Intellectual Disabilities, ADHD
URL: http://www.pslgroup.com/dg/236C3E.htm
Doctor's Guide
April 29, 2009

WASHINGTON, DC -- April 29, 2009 -- A new Cochrane review finds no evidence to support the use of risperidone (Risperdal) to treat attention- deficit/hyperactivity disorder (ADHD) in people with intellectual disabilities, even though the review authors say this is a common prescribing pattern.

"People who have intellectual disability are more likely to receive treatment with second- generation antipsychotics for ADHD," said lead review author Alex Thomson, MD, Kings College, London, United Kingdom.

"Doctors should be aware that there is no research to demonstrate the effectiveness of risperidone for ADHD in people with intellectual disability, and should carefully monitor each case and consider alternative treatments before trying risperidone."

Thomson's research group did not find 1 study that met their criteria for inclusion among more than 2,000 studies that they initially identified. The group analysed 15 studies in depth, but ultimately rejected them all.

"Patients with intellectual disability and their families should be aware that without firm scientific evidence for risperidone's effectiveness as a treatment for ADHD in this group, doctors can only prescribe on a case-by-case basis and such treatment should be regularly reviewed," said Dr. Thomson.

Dr. Thomson and colleagues searched all of the leading medical databases for randomised controlled trials, published and unpublished in any language, in which children or adults who had both an intellectual disability and ADHD underwent treatment with risperidone. They also contacted pharmaceutical companies and experts in the field for relevant studies, published and unpublished.

The researchers cite three previous studies, which indicated that among people with an intellectual disability, symptoms of ADHD are more common, serious and enduring than they are among people of normal intellect. Another earlier study suggested that ADHD symptoms are less responsive to medications in these patients, who might be more prone to side effects.

"This study demonstrates that we have a gap between what we're doing clinically and what we have any research evidence for," commented Laurel Leslie, MD, Tufts University School of Medicine, Boston, Massachusetts. "It's an important study, as it highlights the need for careful consideration of how we treat children's mental health issues." Dr. Leslie has no affiliation with the Cochrane review.

Dr. Leslie said it does not make sense clinically for a doctor to say categorically that when a child has ADHD, he is going to try risperidone. However, she does acknowledge that, in some studies, risperidone has proven helpful in treating aggression, which is often a symptom associated with ADHD.

"The message is not that risperidone should never be prescribed -- we didn't find positive evidence that it doesn't work or is harmful -- but that it should not be prescribed automatically and that it should be regularly reviewed," said Dr. Thomson. "If it is effective for 1 individual, then it could be continued, but if it is not effective, it should be stopped and alternative treatments tried."

SOURCE: Health Behavior News Service

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