🌙 Atypical (Second-Generation) Antipsychotics


What they are:

Atypical antipsychotics are medications that affect dopamine and serotonin pathways. In kids and teens, they’re used not just for psychosis, but also for severe mood swings, aggression, and irritability, especially when safety is a concern.


Common examples:

• Risperidone (Risperdal)

• Aripiprazole (Abilify)

• Quetiapine (Seroquel)

• Olanzapine (Zyprexa)


Uses in children & teens 🧠

• Irritability and aggression related to Autism Spectrum Disorder (risperidone & aripiprazole are FDA-approved for ages 6–17).

• Severe bipolar disorder or schizophrenia in adolescents

• Severe behavior dysregulation when other treatments fail


How they work (simple version):

They “turn down the volume” on overactive dopamine pathways (linked to psychosis and agitation) while also affecting serotonin, which can improve mood and anxiety.


Evidence & stats 📊

• Studies show risperidone and aripiprazole significantly reduce irritability, aggression, and self-injury in autistic youth compared with placebo.

• Use of atypical antipsychotics in children has increased over the past two decades, leading to more guidance on monitoring side effects.


Common side effects:

• Weight gain and increased appetite

• Sleepiness

• Increased cholesterol or blood sugar over time

• Hormone changes (like elevated prolactin with some agents)

• Movement side effects (stiffness, tremor, restlessness) in some children


Safety notes for families ⚠️

• Kids on these meds usually need regular lab work and checks of weight, BMI, and metabolic health.

• They’re powerful tools, generally reserved for moderate to severe symptomswhen the benefits outweigh the risks.


References (Atypical antipsychotics):

• Meza, N., et al. (2022). Atypical antipsychotics for autism spectrum disorder. Cochrane Database / World Journal of Psychiatry.

• Cadenhead, L. M. (2025). Antipsychotics for irritability in autistic youth. U.S. Pharmacist.

• Kohlstadt, I. (2010). Use of atypical antipsychotics in children. American Family Physician.