Risperidone for aggression and self-injurious behavior in adults with mental retardation.

Farrant et al. (1998) tracked eight adults with moderate to profound intellectual disability.

All had long histories of hitting, biting, or head-banging.

Doctors gave each person risperidone and watched what happened. No placebo pills were used.

Aggressive acts and self-injury dropped for every adult.

The main side effects were sleepiness and restlessness.

Because there was no control group, we cannot be sure the drug caused the change.

Amore et al. (2011) later ran a controlled trial and still saw risperidone beat older drugs for aggression, so the early signal may be real.

Titlestad et al. (2019) did the opposite test: they slowly removed risperidone after long use. Irritability did not spike, so the benefit might fade or have been small to start with.

Matson et al. (2008) looked at many adults on atypical antipsychotics and found aggression fell but self-injury stayed flat, clashing with the 1998 claim that both dropped.

van der Miesen et al. (2024) meta-analysis shows strong SIB cuts from behavior plans alone, reminding us drugs are only one tool.

This case series gives the first hint that risperidone might help, but newer studies say the effect is modest and may not last. Before you join a team that wants to start the drug, insist on a fresh FBA and clear response definitions. Track aggression and SIB separately, because the drug seems to work better for hitting than for head-banging. Plan to review the med every few months and pair it with solid behavior support.