Atypical, or second-generation antipsychotics are considered to be the standard treatment for children and adolescents with early-onset schizophrenia and schizoaffective disorder. However, the superiority of atypical antipsychotics over older, first-generation antipsychotics has not been demonstrated. Researchers from a number of different U.S. universities randomly assigned 116 children to receive either the second-generation antipsychotics olanzapine or risperidone or a first-generation drug molindone. Molindone had a better response rate (50%) than olanzapine (34%) or risperidone (46%) although this difference was not statistically significant, and there was no difference between the drugs in terms of symptom reduction. Olanzapine and risperidone showed the greatest risk of weight gain and other metabolic side effects while molindone led to more of the participants saying they suffered from akathisia, an unpleasant feeling of fidgetiness and an inability to sit still.
Sikich, Linmarie ... [et al] - Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizoaffective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study American Journal of Psychiatry November 2008, 165(11), 1420-1431