Atypical Antipsychotics: Risperidone and Aripiprazole

This chapter provides a clear and practical overview of atypical antipsychotics in paediatric neurodevelopmental care, focusing on risperidone and aripiprazole—the most used agents for severe behavioural dysregulation associated with autism. Beginning with the evolution of second-generation antipsychotics, the chapter explains their broad receptor profiles, how dopaminergic and serotonergic modulation reduces aggression, irritability, impulsivity, and repetitive behaviours, and why these medications remain powerful but high-risk tools. The chapter highlights the importance of careful patient selection, thorough psychoeducation, and vigilant monitoring of metabolic, endocrine and neurological side effects. Real-world clinical experience reinforces the need to address environmental and developmental contributors before prescribing antipsychotics, and to regularly review the need for continuation—especially when these medications are started young and not revisited over time. The practical sections on dosing strategies, side-effect mitigation, collaboration with families, and combined or sequential use of antipsychotics offer clinicians a structured and safety-focused approach.