title: Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis.
abstract: BACKGROUND
  Psychotropic medications are frequently used to treat challenging behaviour in children with intellectual disabilities, despite a lack of evidence for their efficacy. This systematic review and meta-analysis aimed to determine the safety and efficacy of pharmacological interventions for challenging behaviour among children with intellectual disabilities.
  
  
  METHODS
  Electronic databases were searched and supplemented with a hand search of reference lists and trial registries. Randomised controlled trials of pharmacological interventions for challenging behaviour among children with intellectual disabilities were included. Data were analysed using meta-analysis or described narratively if meta-analysis was not possible. For quality assessment, the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used.
  
  
  RESULTS
  Fourteen studies including 912 participants met inclusion criteria. Antipsychotic medication reduced challenging behaviour among children with intellectual disabilities in the short-term (SMD = -1.09, p < 0.001 for risperidone; SMD = -0.64, p <0.001 for aripiprazole). However, there were significant side-effects including elevated prolactin levels (SMD = 3.22, p < 0.001) and weight gain (SMD = 0.82, p < 0.001). Evidence was inconclusive regarding the effectiveness of anticonvulsants and antioxidants for reducing challenging behaviour. The quality of all evidence was low and there were no long term follow up studies.
  
  
  CONCLUSIONS
  Antipsychotic medications appear to be effective for reducing challenging behaviour in the short-term among children with intellectual disabilities, but they carry a risk of significant side effects. Findings from this review must be interpreted with caution as studies were typically of low quality and most outcomes were based on a small number of studies. Further long-term, high-quality research is needed to determine the effectiveness and safety of psychotropic medication for reducing challenging behaviour.
authors.affiliation: National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK. mcquirec1@cardiff.ac.uk.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McQuire
authors.affiliation: Division of Psychiatry, University College London, Charles Bell House, 1st and 2nd Floor, 67-73 Riding House Street, London, W1W 7EJ, UK. a.hassiotis@ucl.ac.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Hassiotis
authors.affiliation: National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK. bharrison.rcpsych@live.co.uk.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Harrison
authors.affiliation: Centre for Outcomes Research and Effectiveness, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. spilling@ucl.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pilling
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D002653:Child Behavior Disorders / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000188:drug therapy*; D008297:Male; D061214:Patient Safety; D017060:Patient Satisfaction; D011388:Prolactin / Q000378:metabolism; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D015430:Weight Gain / Q000187:drug effects; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives
chemical_list: D000927:Anticonvulsants; D000975:Antioxidants; D014150:Antipsychotic Agents; D005680:gamma-Aminobutyric Acid; D011388:Prolactin