PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1448 (doi:10.1542/peds.2005-0331)
Use of Risperidone in Developmentally Disabled Children: In Reply
Sarah Shea, MDIWK Health Centre and Dalhousie University
Halifax, Nova Scotia, Canada B3J 3G9
I thank Dr Kastner for his comments and agree that diagnosis must always guide treatment. Indeed, the children enrolled in this trial were known to the investigators and had careful characterization of their clinical profile in addition to trial-related procedures. A clinical determination was made for each child for whether he or she specifically could be expected to benefit from treatment with risperidone, consistent with other such research studies.1 All of the children included in this study were diagnosed with pervasive development disorders by experienced developmental pediatricians or child and adolescent psychiatrists, with expertise in the assessment and management of these disorders and their comorbidities. Children enrolled in this study were selected carefully; children with concomitant active health issues such as uncontrolled seizures were excluded. Behavior intervention therapy, provided it was started 30 days before randomization, could be continued during the trial. Follow-up included comprehensive review for new symptoms, findings, or concerns.
Part of any risk-benefit analysis in deciding whether to treat a child with autism with medication should include an analysis of treatment costs. Medication costs are a part of the larger overall costs associated with the treatment of children with autism. Recently published data on health care utilization and expenditures of children with special needs in an American setting2 show that medication expenses account for 
16.2% of total annual health care costs for their treatments. Other frequently used and necessary interventions include educational programs, other medical care, and psychoeducation and behavioral interventions, as well as supportive therapies such as physical and occupational therapy. A thorough treatment plan for any child with autism should include the evaluation of the need for a variety of services and should be tailored to the needs of the individual child.
Rather than encouraging inappropriate use, well-designed, randomized, controlled, clinical trials add to the available evidence, allowing clinicians to make informed benefit-risk assessments and optimize treatment decisions for each individual patient.
REFERENCES
- McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems.
N Engl J Med. 2002;347
:314
–321
[Abstract/Free Full Text] - Newacheck PW, Kim SE. A national profile of health care utilization and expenditures for children with special health care needs.
Arch Pediatr Adolesc Med. 2005;159
:10
–17
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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