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Antipsychotic Medication in Children and Teens: Summary of Recommendations

Prescription medications called atypical antipsychotics, which include aripiprazole (Abilify), asenapine (Saphris), clozapine (Clozaril), iloperidone (Fanapt), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon), are given to children and teenagers to treat schizophrenia and bipolar disorder. They are also used to try and reduce aggression, irritability, and self-injuring behaviors associated with pervasive developmental disorders, including autism and Asperger syndrome, and disruptive behavior disorders. But prescribing these drugs to young people is controversial because they have not been well-studied, and the long-term safety and effectiveness for children and teens is unknown.

Studies in adults show that atypical antipsychotics can cause serious side effects, so long-term safety is a particular concern about their use in children. Some of the most worrisome side effects include uncontrollable movements and tremors that resemble Parkinson's disease (known as extrapyramidal symptoms), an increased risk of diabetes, substantial weight gain, and elevated cholesterol and triglyceride levels.

In addition, atypical antipsychotic drugs have been shown to increase the risk of premature death, primarily due to strokes, in older adults with dementia.

These risks have been studied primarily in adults—thus, the effects in children are not fully known at this time.

Because of the lack of evidence, we are unable choose a Best Buy atypical antipsychotic for use in kids with schizophrenia, bipolar disorder, pervasive developmental disorders, or disruptive behavior disorders.

Instead, our medical advisors recommend parents carefully weigh the potential risks of atypical antipsychotics against the potential benefits for their children. Kids with these disorders should receive comprehensive treatment that includes cognitive behavioral therapy, parent management training, and specialized educational programs, along with any potential drug therapy.

Deciding whether to use one of these medications at all, and if so, which one, should be done in conjunction with your child's doctor. Important considerations include cost, which can be substantial, potential side effects, and whether the medication has been shown to provide benefit for your child's most prominent condition or symptoms.

If your child has a co-existing condition—for example, ADHD or depression—you should make sure these are appropriately treated because this might improve your child's symptoms.

This information was last updated in March 2012.