RISPERIDONE VERSUS ARIPIPRAZOLE IN TREATING BEHAVIORAL SYMPTOMS IN CHILDREN WITH AUTISM SPECTRUM DISORDER: A NARRATIVE REVIEW OF RECENT STUDIES

Abstract

Objective: to compare, based on evidence published between 2020 and 2025, the clinical efficacy and safety/tolerability profile of risperidone versus aripiprazole for managing behavioral symptoms—irritability, aggression, self-injury, hyperactivity, stereotypies, and social withdrawal—in children and adolescents with autism spectrum disorder (ASD). Methods: narrative review with a systematic search of Medline, LILACS, PubMed, and Google Scholar; inclusion of pediatric studies (ages 4–18) prioritizing randomized controlled trials, systematic reviews, and meta-analyses; primary outcomes were ABC-Irritability and CGI, with metabolic/neurological safety monitoring. Results: both agents significantly reduced irritability and disruptive behaviors. Risperidone yielded faster response and the strongest evidence base but higher metabolic burden (2.5–8.4 kg weight gain over 6–12 months, hyperprolactinemia, sedation). Aripiprazole showed comparable short-/mid-term efficacy, lower weight gain (≈1–3 kg), less prolactin increase, and better adherence; initial akathisia and mild gastrointestinal events were more frequent. Recent guidance highlights laboratory monitoring and the potential role of therapeutic drug monitoring. Conclusion: risperidone and aripiprazole are effective options; selection should be individualized by ASD support level, age, comorbidities, and metabolic risk, alongside psychosocial interventions.