Background: Dysphagia, aspiration pneumonia, constipation and bowel obstruction are serious side effects of antipsychotics, to which individuals with severe developmental disabilities (DD) are more prone. Objectives: To examine antipsychotic treatments with such problems in severe DD, drug taper attempts, and outcomes for dysphagia and oral feeding. Methods: We extracted cases from our IRB-approved Neuropsychiatry Clinical Database with dysphagia, aspiration pneumonia and/or bowel obstruction. Data includes age, race, gender, intellectual disability (ID) level, history of dysphagia/aspiration pneumonia/ bowel obstruction/surgeries for these including ostomy placement and feeding details. Also, antipsychotics at presentation and following dosing reductions and outcomes. Results: Thirteen adults met the inclusion criteria: 7 males, 6 females. Median age was 59 years (range 29-69), all but 2 were < 65 years. One had borderline intellectual functioning and spastic quadriplegia; ID levels were: moderate in 1, severe in 7, and profound in 4. Nine of 13 (69%) had dysphagia; 8 with aspiration pneumonia (62%). Six of 13 (46%) had bowel obstructions. Seven of 13 (54%) had surgery for ostomies or bowel resection. All 13 received antipsychotics: olanzapine in 4: 40mg, 40 mg, 30mg and 25mg daily; clozapine in 3: 750mg (with paroxetine 20mg), 400mg and 375mg daily; quetiapine in 3: 800mg (with paroxetine 30mg), 600mg, 400mg daily; and risperidone in 1: 8 mg daily. Two received olanzapine with a selective serotonin reuptake inhibitor (SSRI) inhibiting CYP2D6: olanzapine 10mg with fluoxetine 80mg daily; olanzapine 20mg with sertraline 150mg daily. Four cases following antipsychotic and/or SSRI tapers showed improved swallowing on repeat video swallow and restoration of normal feeding, less thickened liquids (n=2) or gastrostomy-tube removal (n=2). Conclusions: Individuals with severe DD receiving antipsychotics are prone to dysphagia, aspiration pneumonia, bowel obstruction and surgeries. Gradual taper of such medications, including of CYP2D6-inhibiting SSRIs may improve oral intake outcomes.