The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis.

Researchers ran a three-arm drug trial with the adults who had intellectual disability and serious challenging behavior. Half got risperidone, half got haloperidol, and half got placebo pills for eight weeks.

They tracked both money spent and behavior change. Costs included meds, doctor visits, and extra staff time. Behavior was scored with standard checklists.

At the end, the placebo group cost the least and showed about the same small behavior changes as the drug groups. The antipsychotic pills added roughly £500 per person with no clear extra benefit.

Side-effects like tiredness and weight gain were more common on the drugs. The authors concluded the meds were not cost-effective for this problem.

Thillainathan et al. (2024) just showed the opposite result: a full ABA program in a specialty home cut severe behavior fast and kept costs flat. Their behavioral package outperformed the pills Lawer et al. (2009) tested.

van der Miesen et al. (2024) pooled 98 single-case studies and found huge behavior drops when caregivers used behavioral tricks at home. Again, no drugs were needed.

Capio et al. (2013) did see risperidone beat placebo, but they studied autistic kids, not adults with ID. Same drug, different age and diagnosis — that explains the different outcome.

If a family or funder asks about antipsychotics for challenging behavior in adults with ID, you now have data saying placebo works just as well and costs less. Share the Thillainathan et al. (2024) and van der Miesen et al. (2024) papers to show that behavioral plans work better and keep money in the budget.