Atypical Neuroleptics Cause TD in Children

In 1983, while writing the earliest edition of this book, I became one of the first to conclude and to emphasize that TD is a major risk in children. While too many psychiatrists have continued to minimize the risk to children, awareness has grown. In the 2003 edition of The American Psychiatric Publishing Textbook of Clinical Psychiatry, now in the era of the atypical antipsychotics, Cozza et al. explained, 

Tardive or withdrawal dyskinesias, some transient but others irreversible, seen in 8%-51% of antipsychotic-treated children and adolescents, mandate caution regarding casual use of these drugs. Tardive dyskinesia has been documented in children and adolescents after as brief a period of treatment as 5 months and may appear even during periods of constant medication dose. Cases of tardive dyskinesia have been reported in youths treated with risperidone, indicating that atypical antipsychotics may also cause this serious adverse reaction. 

To further examine the risk of atypical neuroleptics causing TD in children, Wonodi and a team from the Maryland Psychiatric Research Center (2007) followed up 118 children who had been taking neuroleptics, mostly atypicals, for at least 6 months. As a sign of the irrational overprescription of these drugs, only 19% of the children on antipsychotic drugs had ever displayed psychotic symptoms. 

Eleven (9%) of the children developed TD, compared to 0% in a matched control group (p =. 003). The TD rate was particularly high among African American children (15%). Given the relatively short period of exposure, these rates are astronomically high and should discourage any attempts to give neuroleptics, atypical or not, to children. 

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