Posted by developmental pediatrician Daniel Coury, medical director of Autism Speaks Autism Treatment Network (AS-ATN). Dr. Coury is also the chief of developmental-behavioral pediatrics at Nationwide Children’s Hospital, in Columbus, Ohio.
The journal JAMA Psychiatry recently published the results of a large study showing a three-fold increased risk for diabetes among children and young adults taking antipsychotic medications. These medicines include risperidone (Risperdal) and aripiprazole (Abilify) – both FDA-approved for treating severe irritability and disruptive behaviors in children with autism.
This finding is important to the autism community on several levels. Before I discuss them, however, I want to emphasize that, by no means, does this mean that all who take these medicines will develop diabetes. Even with the increased risk seen in this study, diabetes developed in only a fraction of the participants.
Nor do the findings mean that all parents should take their children off anti-psychotic medications. When appropriately used and monitored, these medicines are an important option when other means of addressing severe behavioral challenges fail.
We’ve long known that antipsychotic medicines can produce side effects – including weight gain and the associated risk of diabetes. What this large, new study gives us is the first clear measure of the magnitude of the diabetes risk.
The researchers tracked the outcomes of more than 43,000 patients between the ages of 6 and 24. Among those taking antipsychotic medicines, they found a diabetes rate of about 24 cases per 10,000 person years. By comparison the diabetes rate for those taking other psychiatric medicines (mood stabilizers, antidepressants, etc.) was about 8 cases per 10,000 person years. (One person year translates to one patient followed for one year. Two person years could be one patient followed for two years or two patients followed for one year, and so on.)
These findings underscore the importance of our AS-ATN’s guidelines for the use of antipsychotic medicines. When a family comes to one of our centers seeking help for severe behavioral issues, the first step is to look for underlying medical problems, sensory issues and communication difficulties that may be causing a child to “act out.” The classic example is the pain of GI distress – all too common among individuals with autism.
Even after these issues have been addressed or ruled out, behavioral therapies should always be the first step in helping individuals with autism resolve problem behaviors.
If a family and doctor agree to try an antipsychotic medicine, our guidelines call for careful monitoring for signs and symptoms of a number of potential side effects. We recommend a check of blood glucose, blood lipids, weight, blood pressure, body mass index (BMI) and an evaluation for motor problems (dyskinesias) that may indicate unwanted neurological effects. These evaluations should be performed when a medicine is started, 6 months later and then annually. Appearance of side effects warrants adjustment, change or discontinuation of medication.
Unfortunately, this type of gold-standard evaluation and monitoring is not yet the norm outside our AS-ATN centers. As part of our mission, we are redoubling our efforts to educate community physicians of these best practices.
If you have concerns, please raise them with your child’s doctor. To help you better understand and work through these issues, we have two AS-ATN tool kits that you can download for free from this website:
The AS-ATN/AIR-P Medication Decision Aid helps families and clinicians evaluate whether behavioral medicines are right for their child.
The AS-ATN/AIR-P Autism and Medication: Safe and Careful Use helps families and clinicians monitor how well a medicine is working as well as potential side effects.
We’d love to hear from you about your experiences. Please leave a comment below or email us at GotQuestions@AutismSpeaks.org
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