The effectiveness of aripiprazole in the management of problem behaviour in people with intellectual disabilities, developmental disabilities and/or autistic spectrum disorder--a systematic review.
Aripiprazole can dampen problem behavior in IDD/ASD, yet the evidence is thin, industry-linked, and carries clear safety trade-offs.
01Research in Context
What this study did
Deb et al. (2014) hunted every trial that gave aripiprazole to people with intellectual disability, developmental delay, or autism.
They screened papers for any sign the drug cut problem behavior.
The team also pulled out side-effect numbers and rated how solid each study was.
What they found
Aripiprazole can calm hitting, yelling, and self-injury, but most proof is weak.
Many studies were short, small, or funded by the drug maker.
Weight gain, sleepiness, and movement twitches showed up again and again.
How this fits with other research
Hudson et al. (2012) came first and said the same thing: only a few antipsychotics have good data in autism.
Houghton et al. (2021) looked deeper and found kids on aripiprazole break bones 40 % more often than kids on risperidone after six months.
Cox et al. (2022) flipped the question: when staff changed teaching plans instead of pills, behavior dropped more than when they raised the dose.
Bird et al. (2022) showed an interdisciplinary team can safely cut or stop psychotropics when everyone shares data.
Why it matters
If a family asks about aripiprazole, you can say it might help but the science is shaky and side effects are real.
Pair any med trial with tight behavior data and a plan to taper if teaching works.
Share Richard’s bone-risk finding so parents watch for falls and doctors check vitamin D.
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02At a glance
03Original abstract
The management of problem behaviours (PB) in individuals with intellectual disabilities (ID), developmental disabilities (DD) and/or autistic spectrum disorders (ASD) can be challenging. Antipsychotic medications are commonly prescribed where other strategies have failed. A systematic review (SR) was conducted to establish the research evidence for the efficacy of aripiprazole in the management of PB in adults and children with ID, DD and/or ASD. Although included studies supported the efficacy of aripiprazole for this indication, the overall quality of studies was poor. Of the 20 studies included in this systematic review there were only two randomised controlled trials (RCTs) on children with ASD and/or ID/DD, both of which were conducted by the pharmaceutical company that manufactures aripiprazole, and it is not clear whether a number of same participants were included in both RCTs. One of the RCTs was extended into an open label long term follow up, which showed that aripiprazole's efficacy lasted over 52 weeks and the adverse effects were tolerable. Four studies were open label prospective studies, 11 were retrospective case reports which included four single case reports, and two were prospective case series. Most studies reported adverse effects from aripiprazole in the form of weight gain, increased appetite, sedation, tiredness, drooling and tremor. However, aripiprazole improved serum prolactin level in some participants and overall did not show any adverse effect on QTc interval. There is a need for more carefully designed RCTs into the use of aripiprazole in the management of PB in people with ID/DD and/or ASD, which should be carried out independent of pharmaceutical companies.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2013.12.004