Children with psychotic and/or violence problems are at extreme risk - they can severely injure others and/or themselves. The long term damage to the child (and others) of violent out of control behavior is astronomical and often irreparable.

Risperdal (risperdone) is a powerful "antipsychotic" "major tranquilizer" which in my opinion has no equal in controlling these symptoms. Many child psychiatrists and pediatric psychiatric institutions are increasingly using Risperdal for one major reason - it works, and it works well.

Side effects and dosing are the biggest problems. The major side effects are grogginess (which can be severe) and dizziness when standing up. An uncommon, but frightening side effect can occur, called a dystonic reaction - where the child can have enormous muscle spasms including a twisting of the head and/or eyes. This can be treated with the over the counter antihistamine Benadryl (diphenhydramine). Higher doses of Benadryl may be necessary, up to 100mg. If the symptoms reoccur, the dose will need to be reduced, medication to stop the side effect will be necessary, or the Risperdal will need to be stopped. Dystonic reactions are scary, but not very dangerous.

Doses range from 0.5mg to 3mg. There are many variations. Some very tiny children require high doses and get no side effects. Some large children require low doses and have enormous side effects. There is no way to predict. My usual approach is to try a middle area - and make adjustments as needed. The number one priority, however, is to stop all dangerous behavior as soon as possible. Underlying causes of the problems, especially depression, can then be treated. Over time the Risperdal will be stopped.