Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial
- PMID:19858761
- PMCID: PMC3142923
- DOI: 10.1097/CHI.0b013e3181bfd669
Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial
Erratum in
- J Am Acad Child Adolesc Psychiatry. 2010 Jul;49(7):727
Abstract
Objective: Many children with pervasive developmental disorders (PDDs) have serious, functionally impairing behavioral problems. We tested whether combined treatment (COMB) with risperidone and parent training (PT) in behavior management is superior to medication alone (MED) in improving severe behavioral problems in children with PDDs.
Method: This 24-week, three-site, randomized, parallel-groups clinical trial enrolled 124 children, aged 4 through 13 years, with PDDs, accompanied by frequent tantrums, self-injury, and aggression. The children were randomized 3:2 to COMB (n = 75) or MED (n = 49). The participants received risperidone monotherapy from 0.5 to 3.5 mg/day (with switch to aripiprazole if risperidone was ineffective). Parents in the COMB group (n = 75; 60.5%) received a mean of 10.9 PT sessions. The primary measure of compliance was the Home Situations Questionnaire (HSQ) score.
Results: Primary: intent-to-treat random effects regression showed that COMB was superior to MED on HSQ (p = .006) [effect size at week 24 (d) = 0.34]. The HSQ score declined from 4.31 (± 1.67) to 1.23 (± 1.36) for COMB compared with 4.16 (± 1.47) to 1.68 (± 1.36) for MED. Secondary: groups did not differ on Clinical Global Impressions-Improvement scores at endpoint; compared with MED, COMB showed significant reductions on Aberrant Behavior Checklist Irritability (d = 0.48; p = .01), Stereotypic Behavior (d = 0.23; p = .04), and Hyperactivity/Noncompliance subscales (d = 0.55; p = .04). Final risperidone mean dose for MED was 2.26 mg/day (0.071 mg/kg), compared with 1.98 mg/day for COMB (0.066 mg/kg) (p = .04).
Conclusions: Medication plus PT resulted in greater reduction of serious maladaptive behavior than MED in children with PDDs, with a lower risperidone dose.
Trial registration: ClinicalTrials.govNCT00080145.
Similar articles
- Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems.Scahill L, McDougle CJ, Aman MG, Johnson C, Handen B, Bearss K, Dziura J, Butter E, Swiezy NG, Arnold LE, Stigler KA, Sukhodolsky DD, Lecavalier L, Pozdol SL, Nikolov R, Hollway JA, Korzekwa P, Gavaletz A, Kohn AE, Koenig K, Grinnon S, Mulick JA, Yu S, Vitiello B; Research Units on Pediatric Psychopharmacology Autism Network.Scahill L, et al.J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):136-46. doi: 10.1016/j.jaac.2011.11.010. Epub 2011 Dec 23.J Am Acad Child Adolesc Psychiatry. 2012.PMID:22265360Free PMC article.Clinical Trial.
- Research Units of Pediatric Psychopharmacology (RUPP) autism network randomized clinical trial of parent training and medication: one-year follow-up.Arnold LE, Aman MG, Li X, Butter E, Humphries K, Scahill L, Lecavalier L, McDougle CJ, Swiezy NB, Handen B, Wilson K, Stigler KA.Arnold LE, et al.J Am Acad Child Adolesc Psychiatry. 2012 Nov;51(11):1173-84. doi: 10.1016/j.jaac.2012.08.028. Epub 2012 Oct 9.J Am Acad Child Adolesc Psychiatry. 2012.PMID:23101743Free PMC article.Clinical Trial.
- Predictors and moderators of parent training efficacy in a sample of children with autism spectrum disorders and serious behavioral problems.Farmer C, Lecavalier L, Yu S, Eugene Arnold L, McDougle CJ, Scahill L, Handen B, Johnson CR, Stigler KA, Bearss K, Swiezy NB, Aman MG.Farmer C, et al.J Autism Dev Disord. 2012 Jun;42(6):1037-44. doi: 10.1007/s10803-011-1338-2.J Autism Dev Disord. 2012.PMID:21822762Free PMC article.Clinical Trial.
- Atypical antipsychotics for disruptive behaviour disorders in children and youths.Loy JH, Merry SN, Hetrick SE, Stasiak K.Loy JH, et al.Cochrane Database Syst Rev. 2012 Sep 12;(9):CD008559. doi: 10.1002/14651858.CD008559.pub2.Cochrane Database Syst Rev. 2012.Update in:Cochrane Database Syst Rev. 2017 Aug 09;8:CD008559. doi: 10.1002/14651858.CD008559.pub3.PMID:22972123Updated.Review.
- Role of risperidone in children with autism spectrum disorder.Chavez B, Chavez-Brown M, Rey JA.Chavez B, et al.Ann Pharmacother. 2006 May;40(5):909-16. doi: 10.1345/aph.1G389. Epub 2006 Mar 7.Ann Pharmacother. 2006.PMID:16684811Review.
Cited by
- Friends not foes: combined risperidone and behavior therapy for irritability in autism.Frazier TW.Frazier TW.J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):129-31. doi: 10.1016/j.jaac.2011.10.017.J Am Acad Child Adolesc Psychiatry. 2012.PMID:22265357Free PMC article.No abstract available.
- Atomoxetine and Parent Training for Children With Autism and Attention-Deficit/Hyperactivity Disorder: A 24-Week Extension Study.Smith T, Aman MG, Arnold LE, Silverman LB, Lecavalier L, Hollway J, Tumuluru R, Hyman SL, Buchan-Page KA, Hellings J, Rice RR Jr, Brown NV, Pan X, Handen BL.Smith T, et al.J Am Acad Child Adolesc Psychiatry. 2016 Oct;55(10):868-876.e2. doi: 10.1016/j.jaac.2016.06.015. Epub 2016 Aug 2.J Am Acad Child Adolesc Psychiatry. 2016.PMID:27663942Free PMC article.Clinical Trial.
- Clinical approach to motor stereotypies in autistic children.Ghanizadeh A.Ghanizadeh A.Iran J Pediatr. 2010 Jun;20(2):149-59.Iran J Pediatr. 2010.PMID:23056697Free PMC article.
- Parent Training for Feeding Problems in Children With Autism Spectrum Disorder: Initial Randomized Trial.Johnson CR, Brown K, Hyman SL, Brooks MM, Aponte C, Levato L, Schmidt B, Evans V, Huo Z, Bendixen R, Eng H, Sax T, Smith T.Johnson CR, et al.J Pediatr Psychol. 2019 Mar 1;44(2):164-175. doi: 10.1093/jpepsy/jsy063.J Pediatr Psychol. 2019.PMID:30101320Free PMC article.Clinical Trial.
- Regulating Together: Emotion Dysregulation Group Treatment for ASD Youth and Their Caregivers.Shaffer RC, Schmitt LM, Reisinger DL, Coffman M, Horn P, Goodwin MS, Mazefsky C, Randall S, Erickson C.Shaffer RC, et al.J Autism Dev Disord. 2023 May;53(5):1942-1962. doi: 10.1007/s10803-022-05461-x. Epub 2022 Feb 9.J Autism Dev Disord. 2023.PMID:35141815Free PMC article.
References
- American Psychiatric Association. Diagnostic and Statistical Manual of mental Disorders. 4. Washington DC: American Psychiatric Association; 2000. Text Revision.
- Lecavalier L. Behavioral and emotional problems in young people with pervasive developmental disorders: Relative prevalence, effects of subject characteristics, and empirical classification. J Autism Dev Disord. 2006;36:1101–1114. - PubMed
- Gadow KD, DeVincent CJ, Pomeroy J, Azizian A. Comparison of DSM-IV symptoms in elementary school-aged children with PDD versus clinic and community samples. Autism. 2005;9:392–415. - PubMed
- Tonge BJ, Einfeld SL. Psychopathology and intellectual disability: The Australian Child to Adult Longitudinal Study. In: Glidden LM, editor. International Review of Research in Mental Retardation. Vol. 26. San Diego: Academic Press; 2003. pp. 61–91.
- Williams SK, Scahill L, Vitiello B, Aman MG, Arnold LE, McDougle CJ, McCracken JT, Tierney E, Ritz L, Posey DJ, Swiezy NB, Hollway J, Cronin P, Ghuman J, Wheeler C, Cicchetti D, Sparrow S. Risperidone and adaptive behavior in children with autism. J Am Acad Child Adolesc Psychiatry. 2006;45:431–439. - PubMed
Publication types
MeSH terms
Substances
Associated data
Related information
Grants and funding
LinkOut - more resources
Full Text Sources
Medical