The use of atypical antipsychotic medications in the treatment of children and adolescents with avoidant/restrictive food intake disorder

Eur Child Adolesc Psychiatry. 2025 Apr 24. doi: 10.1007/s00787-025-02713-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Avoidant restrictive food intake disorder (ARFID) is a childhood feeding and eating disorder often associated with marked physical and psychosocial impairment.

OBJECTIVE: We assessed the use of atypical antipsychotic (AAP) medications (mostly risperidone) in promoting weight and height gain in children with ARFID.

METHODS: The computerized medical records of 21 children with ARFID receiving AAPs in one center in Israel were retrospectively reviewed. Fourteen children received AAPs after 6.30 ± 0.75 months of no weight gain with treatment as usual (either group or individual cognitive behavioral therapy); seven children were admitted to our clinic receiving AAPs in previous facilities because of lack of weight gain. All were followed-up for 18 months. Weight and height were extracted from the medial records at eight time points.

RESULTS: A significant increase was found in weight, height, and body mass index (BMI) over 18 months of treatment with AAPs (Δweight: 9.66 ± 9.24 kg, p < 0.001; Δheight: 10.23 ± 11.54 cm, p < 0.001; ΔBMI = 2.55 ± 1.53 kg/m²; p < 0.001). Weight increased significantly for both sexes, while height increased significantly only for boys. Patients with both low and high baseline BMI percentiles gained weight, while mean height increased significantly over time only for children with low BMI percentile. The use of a retrospective clinical global impression scale indicated a marked improvement over time. Adverse effects were minimal, and no patients discontinued AAPs due to adverse events.

CONCLUSION: The addition of AAPs for a period of 18 months may be safe and effective in increasing weight and height in children with ARFID.

PMID:40272541 | DOI:10.1007/s00787-025-02713-w