Beta blockers in mental retardation and developmental disorders

ABSTRACT beta-Adrenergic blockers appear to be effective in the management of verbal aggression, physical aggression, or self-injurious behavior associated with mental retardation and other developmental disorders. However, methodological limitations of the available studies make it difficult to judge the value of these treatments. Optimal doses for treating patients with mental retardation or developmental disorders appear lower than described in the general psychiatric literature, so low doses of beta-blockers may be preferred in such patients with abnormal brain development. Children and adolescents with mental retardation or developmental disorders appear to respond to particularly low doses (e.g., below propranolol 150 mg daily). Propranolol is recommended for central blockade, and nadolol is recommended for peripheral blockade. Most beta receptors in the brain (except cerebellum) seem to be beta(1) (cardiac type), but it is not clear that central blockade is required for psychotropic effects. Interim suggestions for empirical trials are offered, and rating scales and other measurement approaches are discussed. Since evidence supporting the efficacy of beta-blockers in mental retardation or developmental disorders in children and adolescents is not definitive, the clinician is advised to consider designing an empirical trial for each patient, utilizing pre- and postmedication measures, when conventional treatments have been unsuccessful.