"I’ve had three kids in my practice [who] developed clear symptoms of tardive dyskinesia on risperidone that went away when the medication was taken away," he said. "Some parents are willing to take the risk, but it’s a risk I have them write about."
He’s also had younger girls or boys develop breast buds on risperidone and lactate. In those cases, he usually switches to aripiprazole, though sometimes, children don’t do as well.
Lowering the risperidone dose is another option. "I have some children [whom] I’ve kept just below lactating on risperidone," he said.
When all else fails, there’s some evidence to support propranolol and low-dose naltrexone cream for aggression; divalproex might help affect instability.
Amantadine, d-cycloserine, memantine, cholinesterase inhibitors, and nicotinic agonists all have studies suggesting a small effect size, he said.
Dr. Hendren disclosed that he is an adviser to BioMarin Pharmaceutical Inc., and receives research funding from that company plus Curemark LLC, Forest Laboratories Inc., and Autism Speaks.