Dosing of Atypical Antipsychotics in Children and Adolescents

Atypical antipsychotic medications are increasingly used to treat children and adolescents with a variety of neuropsychiatric disorders. The most common symptom for which atypical antipsychotics are prescribed to young patients is pernicious, pervasive, persistent aggression in the context of disruptive behavior disorders. Unfortunately, the evidence base informing physicians about atypical antipsychotic dosing in young people is relatively small, and high rates of neuropsychiatric comorbidity in pediatric populations can increase the risk of overmedication. A growing body of evidence regarding some pediatric neuropsychiatric conditions suggests that focused combination pharmacotherapy, particularly in cases of comorbidity, may be a rational choice. Specifically, a targeted treatment approach that combines a psychostimulant and an atypical antipsychotic, each at the lowest effective dose, might be the most effective means of treating some patients with the common pediatric comorbidity of attention-deficit/hyperactivity disorder and aggressive disruptive behavior disorder. Available data, though few, seem to suggest that the combination of a psychostimulant with the atypical antipsychotic risperidone may be safe and well tolerated in this patient population.