Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis

McQuire, Cheryl, Hassiotis, Angela, Harrison, Bronwyn and Pilling, Steve 2015. Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis. BMC Psychiatry 15 (303) , pp. 1-13. 10.1186/s12888-015-0688-2

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Abstract

Background Psychotropic 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. Methods Electronic 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. Results Fourteen 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. Conclusions Antipsychotic 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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services R Medicine > RM Therapeutics. Pharmacology
Uncontrolled Keywords:	Intellectual disabilities, Challenging behaviour, Pharmacological treatment, Antipsychotics, Systematic review, Meta-analysis, Randomised controlled trials
Additional Information:	© 2015 McQuire et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Publisher:	BioMed Central
ISSN:	1471-244X
Funders:	The full guideline from which this review was derived was funded by the National Institute for Health and Care Excellence (NICE).
Related URLs:	Publisher
Date of First Compliant Deposit:	30 March 2016
Date of Acceptance:	20 November 2015
Last Modified:	15 May 2023 03:20
URI:	https://orca.cardiff.ac.uk/id/eprint/85151

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