238 The Explosive ChildEXTREMELY SHORT FUSEIf—despite heavy doses of Plan C—your child’s fuse is
still so short that he is incapable of participating in Plan B
discussions, a class of medications called atypical
antipsychotics—including medications such as risperi-
done (Risperdal), olanzipine (Zyprexa), quetiapine
(Seroquel), and aripiprazole (Abilify) may be used. These
medications have prompted much enthusiasm because
they tend to be better tolerated than more traditional an-
tipsychotics. However, these agents have been associated
with sedation and significant weight gain, and may be as-
sociated with extrapyramidal symptoms, such as odd
mouth or tongue movements, eye rolling, rigidity in the
limbs, fixed facial expression, blank emotions, and invol-
untary movements. These symptoms typically subside
once the medication is discontinued; however, in rare in-
stances, they may persist even after the child is taken off
the medication (a condition called tardive dyskinesia).
Another class of agents—broadly referred to as
mood stabilizers—may also be prescribed, including
lithium carbonate, carbamazepine (Tegretol), and val-
proic acid (Depakote). The mood stabilizers may be less
effective in children who are predominantly dysphoric.
Indeed, because these agents may produce drowsiness
or fatigue, they may actually increase irritability in
some children. All of these agents provide twenty-four-