Abstract
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Aman et al. describe a follow-up to an earlier Research Units on Pediatric Psychopharmacology Autism Network investigation of risperidone in autistic youth with severe irritability and aggression. Having shown atypical antipsychotics to be effective in addressing these symptoms in the short term, the authors look to questions surrounding chronic usage, 21 months in this case. Is there continued, even enduring benefit to drug exposure? What risks and adverse events emerge over time? And do these findings suggest a balance in favor of continued risperidone use?
The community-care status of the subjects goes far to answer the last question. “At 1.8 years after starting risperidone,” Aman et al. write, “67% of young people with autism continued to receive the drug.” This “high rate of continued risperidone treatment suggests that sustained benefits were perceived by parents and prescribers,” which is “bolstered by other observations, such as parent ratings of reduced maladaptive behaviors, reduced autism spectrum disorder symptoms, and even possible gains in Vineland Adaptive Behavior Scale social skills in those with the greatest and most recent risperidone exposure.”
Aman et al. have much more to add, including discussions of the limitations of certain study instruments and the challenges of gauging developmental changes against drug effects. Suffice it to say, in the authors' words: “These data, with comprehensive follow-up assessments, form an important addition to the limited knowledge base on longer exposures to antipsychotics in children and adolescents.”
Lambert et al. cast an epidemiological eye on the use of stimulants to treat attention-deficit/hyperactivity disorder, with results that confirm the experience of many clinicians. In their large Australian sample the authors found treatment to be relatively short-lived. “The average child in this study would begin medication at age 10 and discontinue medication by age 12,” they write. “This poses a potentially serious clinical treatment concern.”
Here, the authors approach similar issues as those of Aman et al., but from a different direction. “What is the expected right length of medication treatment for a chronic psychiatric condition that has been seen to respond to medication?” Lambert et al. ask. It's a vital question, and the authors know better than to answer it. Rather, they write, “until this question can be addressed with empirical data, concerns over whether children and youth remain on medication too long (or not long enough) would appear speculative and prone to sensationalism.”
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