Pharmacotherapy

Drugs, if used, should be part of a broader psychosocial and educational approach to management and the physician must be mindful of the need for informed parent/carer consent. As for child psychiatry in general, evidence for the efficacy of psychotropic drugs is relatively limited. A series of recent working parties has produced an international consensus on psychopharmacotherapy in developmental disability, but this still relates mainly to adults. (78,) For conditions that children with mental retardation show in common with other children, drugs that have been shown to be effective are used, such as stimulant medication, clonidine, neuroleptic drugs, and imipramine for ADHD, clomipramine and selective serotonin reuptake inhibitors ( SSRIs) for obsessive-compulsive disorder, SSRIs and tricyclic antidepressants for depression, and neuroleptic drugs for tic disorders.

Drugs also have a role in the treatment of behavioural problems more specific to children with mental retardation. Haloperidol and other neuroleptic drugs reduce aggression, hyperactivity, and stereotypic behaviour, although they are associated with drowsiness and with extrapyramidal and dystonic side-effects. (79)

Anticonvulsants (e.g. sodium valproate and carbamazepine), lithium, b-blockers, and buspirone have been shown, mostly in open trials, to reduce self-injurious, aggressive, disruptive, explosive, and agitated behaviour, particularly when there is a history of cycling mood. (7 89 The opiate antagonists naloxone and naltrexone may reduce self-injurious behaviour. (81>

The prescription of psychotropic drugs requires regular follow-up to monitor compliance, side-effects, acceptability, and therapeutic response. Response to treatment is best assessed using a combination of behavioural observation and carer-completed symptom checklist such as the Developmental Behaviour Checklist (!5> or the Nisonger Child Behaviour Rating Form.(82)

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