From the Guidelines
Risperidone is the preferred choice for treating conduct disorder in pediatric patients due to its established efficacy and safety profile, as supported by recent studies 1. When considering the treatment of conduct disorder in children, it's essential to weigh the benefits and risks of available medications.
- Risperidone has been shown to improve symptoms of irritability and aggression, as well as problem behaviors associated with conduct disorder, with positive findings typically starting within 2 weeks of initiation 1.
- The most common side effects of risperidone include headache and somnolence, with a comparable extrapyramidal symptom profile to placebo, but it can cause weight gain and asymptomatic increases in prolactin 1.
- Aripiprazole is an alternative option, but the provided evidence does not specifically support its use for conduct disorder in pediatric patients.
- Treatment with risperidone should be initiated at a low dose, typically 0.25-0.5 mg daily for younger children or 0.5 mg daily for adolescents, and gradually titrated up as needed to a typical range of 0.5-3 mg daily divided into 1-2 doses.
- Regular assessment of side effects, including weight, metabolic parameters, and movement disorders, is crucial and should be performed every 3-6 months.
- Medication should be part of a comprehensive treatment plan that includes behavioral therapy and family interventions, and treatment duration should be individualized, with periodic attempts to reduce or discontinue medication considered after 6-12 months of stability 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Risperidone for Conduct Disorder in Paediatrics
- Risperidone has been shown to be effective in the management of disruptive behavior disorders, including conduct disorder, in pediatric patients 2, 3, 4.
- Studies have demonstrated that risperidone can improve angry, aggressive, self-injurious, and disruptive symptoms and behavior in children with conduct disorder 2, 4.
- Risperidone has been found to be well-tolerated in pediatric patients, with common side effects including sedation, weight gain, and metabolic disturbances 3, 4.
Aripiprazole for Conduct Disorder in Paediatrics
- There is evidence to support the short-term efficacy of aripiprazole for irritability in autism spectrum disorder (ASD), but limited data on its use for conduct disorder specifically 5.
- Aripiprazole has been shown to be effective in reducing aggressive and disruptive behavior in patients with ASD, but its use in conduct disorder is not well-established 5.
Comparison of Risperidone and Aripiprazole
- Both risperidone and aripiprazole have been found to be effective in reducing symptoms of disruptive behavior disorders, but risperidone has a more established track record for conduct disorder specifically 2, 3, 4, 5.
- The use of antipsychotics, including risperidone and aripiprazole, should be reserved for pediatric patients with conduct disorder who are refractory to first and second-line therapies and pose a persistent and serious risk of harm to self or others 5.