Question: In adults with learning disabilities how effective are pharmacological interventions in the management of challenging behaviour?

Answer:

The studies included in this evidence summary do not provide strong support for the effectiveness of any pharmacological intervention in reducing challenging behaviour in adults with learning disabilities. There was some, very limited evidence (one very small RCT included in a systematic review) that risperidone may have some effectiveness in managing challenging behaviour in adults with autistic disorders. Evidence on the effectiveness of risperidone for the management of challenging behaviour in adults with learning disabilities was contradictory; one high quality RCT found no statistically significant difference between risperidone and placebo on any behavioural measure and one moderate quality RCT found significant improvements in Aberrant Behaviour Checklist (ABC) score, Behaviour Problems Inventory (BPI) and care giver-assessed VAS scale for aggressive behaviour associated with risperidone treatment compared to placebo. There was no evidence for a significant treatment effect associated with any other antipsychotic medication assessed. One systematic review, which had a number of methodological limitations, provided some evidence to support the use of lithium and some antiepileptic mood stabilizer medications for the management of behaviour problems in adults with learning disabilities; the authors of this review noted the methodological weakness of included studies and advised cautious interpretation.

Further research is needed to determine the effectiveness of pharmacological interventions in managing challenging behaviour in adults with learning disabilities. In particular, further RCTs are needed to confirm the effectiveness, or otherwise, of antipsychotic medications in managing challenging behaviour in adults with autistic disorders.