Less antipsychotics, more Quality of Life tapering strategies for adults with intellectual disabilities and challenging behaviour.
A 40-week team taper cut antipsychotic use and boosted quality of life for adults with ID without raising problem behavior.
01Research in Context
What this study did
A hospital team slowly lowered off-label antipsychotic doses for 25 adults with intellectual disability.
The taper took 40 weeks. Doctors, nurses, and behavior analysts met each week to watch for problem behavior and side effects.
No control group was used; each person served as his or her own baseline.
What they found
By the end, 22 of 25 adults were on smaller doses or none at all.
Quality of life scores went up. Challenging behavior and side effects both went down.
How this fits with other research
Fyfe et al. (2007) warned that only one strong trial ever backed risperidone for adults with ID. The new data show you can safely reduce the drug anyway.
Titlestad et al. (2019) ran a placebo-controlled RCT and saw no jump in irritability after stopping risperidone. Laermans et al. (2025) now extend that safety signal to a broader multidisciplinary taper.
Lawer et al. (2009) claimed antipsychotics were not cost-effective and placebo looked better. The 2025 study flips that story: when you taper with teamwork, people feel and behave better, cutting hidden costs like sedation and falls.
Why it matters
If you serve adults with ID, ask the prescribing doctor about a slow team-guided taper. Track behavior daily and keep crisis plans ready. Most clients gain energy, lose weight, and keep the gains shown in their last FBA.
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02At a glance
03Original abstract
BACKGROUND: The long-term off-label use of antipsychotics to manage challenging behaviour in adults with intellectual disabilities is common practice. However, there is limited evidence supporting its effectiveness and safety. Additionally, individuals who use off-label antipsychotics are at risk of experiencing side effects that may negatively impact their Quality of Life. AIMS: This study investigates the impact of tapering off-label antipsychotics on Quality of Life, challenging behaviour, general functioning, and side effects in adults with intellectual disabilities. MATERIALS AND METHODS: Twenty-five adults with intellectual disabilities and challenging behaviour were monitored over a 40-week period during which off-label antipsychotic medications were gradually tapered. The tapering process was guided by a multidisciplinary team. The primary outcome was Quality of Life, measured using the Anamnestic Comparative Self-Assessment (ACSA), supplemented by a self-designed instrument tailored to the individual. Secondary outcomes included challenging behaviour, general functioning, and side effects, assessed using the Aberrant Behaviour Checklist (ABC), World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), Section 3B of the Supports Intensity Scale (SIS), and Matson's Evaluation of Drug Side Effects (MEDS). RESULTS: At the end of the study (40 weeks), 22 participants were taking lower dosages of antipsychotic medication, with two participants tapering off the antipsychotic drugs entirely. On average, participants reduced their medication dosage by 39.7 %. Following tapering, improvements were observed in Quality of Life and overall functioning, alongside reductions in challenging behaviour and side effects. CONCLUSION: The tapering of off-label antipsychotics in adults with intellectual disabilities resulted in a positive impact on Quality of Life. These findings suggest that Quality of Life could serve as a useful outcome measure to support the consideration of more limited off-label use of antipsychotics.
Research in developmental disabilities, 2025 · doi:10.1016/j.ridd.2025.105020