A 24-month observational study in Italy reveals that while second-generation antipsychotics are generally tolerated in children and adolescents, long-term metabolic risks such as weight gain and insulin resistance require continuous monitoring, especially in those with autism and older teens.
A new Frontiers in Psychiatry study suggests that second-generation antipsychotics can be used with reasonable short-term tolerability in children and adolescents, but that metabolic monitoring remains essential over the long term. In a 24-month prospective observational cohort of 82 young patients in Italy, treatment continuation was generally good and discontinuation because of side effects was uncommon, yet body mass index, fasting insulin and insulin resistance all rose over time.
The study followed children and adolescents starting either risperidone or aripiprazole in routine care. According to the authors, the two medicines did not differ meaningfully in overall retention, but they did show different safety patterns. Risperidone was linked with greater increases in waist circumference, prolactin, total cholesterol and alanine aminotransferase, a liver enzyme. Aripiprazole appeared to have a milder profile on those measures, although it was not free of metabolic change.
The cohort was clinically complex, with high rates of conduct problems, intellectual disability, epilepsy and autism spectrum disorder. That matters because the researchers found that young people with autism had steeper rises in body mass index, waist circumference and systolic blood pressure than their peers without autism. Older adolescents also appeared more vulnerable to some metabolic changes, and higher risperidone doses were associated with greater weight gain. By contrast, heart rate and QTc, a measure of electrical activity on ECGs, did not show significant long-term change.
The findings fit a broader pattern described in earlier paediatric antipsychotic research: weight gain and metabolic changes can emerge quickly and may continue beyond the first months of treatment. The study’s observational design means it cannot prove the medicines caused the changes, and the authors note that diet, activity levels and pubertal stage were not formally measured. Even so, the message is clear: children and adolescents receiving these drugs need regular, structured follow-up, not only at the start of treatment but throughout it.
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