The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities.
Only one solid trial supports risperidone for adults with ID, so insist on a new FBA before any script or refill.
01Research in Context
What this study did
The authors hunted for every paper that tested antipsychotic drugs in adults with intellectual disability.
They kept only studies with clear behavior data. In the end they found just one strong trial and many weaker ones.
What they found
Only one randomized trial backed risperidone. The rest were small case reports or open studies.
They say always run a fresh FBA before writing any script.
How this fits with other research
Titlestad et al. (2019) later showed you can taper risperidone after long use without more irritability. This extends the 2007 call for careful review.
Lawer et al. (2009) found the same drug costs more yet fares no better than placebo. The two papers seem to clash, but R looked at cost while S looked at scarce evidence.
Laermans et al. (2025) cut doses slowly and saw better quality of life and less problem behavior. This supports the 2007 warning that pills are rarely the full answer.
Why it matters
You now have clear footing when the team wants to start or keep antipsychotics. Ask for a fresh FBA and a taper plan. Show the long-term data that behavior can stay stable or improve with less medication. Your advocacy can spare clients excess pills, weight gain, and cost.
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02At a glance
03Original abstract
BACKGROUND: Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use. METHODS: A comprehensive systematic review of empirical research on the effectiveness of antipsychotic medication was conducted. Electronic and manual searches of literature were conducted. Stringent scientific methodology determined those primary trials that were worthy of inclusion. RESULTS: This review revealed one randomized controlled trial (RCT), one controlled, four uncontrolled prospective and three retrospective case series studies in adults. Additionally, two studies in both adults and children--one crossover RCT and one prospective controlled trial--were found. CONCLUSION: Presently, there is RCT-based evidence for risperidone to be effective in both adults and children; however, this treatment carries a certain amount of risk associated with adverse effects. There is also evidence to support the use of other antipsychotics, primarily atypicals, but the evidence is based on noncontrolled case studies. There is currently not enough evidence available to recommend specific medication for specific behaviour problems. Before prescribing medication, clinicians should carry out a thorough assessment of behaviour, including its causes and consequences, and draw up a formulation providing the rationale for the prescribed intervention after considering all medication- and nonmedication-based management options.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2007.00950.x