Abstract
Over the past 20 years, there has been an increase in the identification of children with autism and phenotypically related conditions, Asperger disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) (Fombonne 2005). This increased recognition has brought in its wake greater demand for interventions – educational, psychosocial and psychopharmacological. A look at the literature over the past 20 years shows a rather impressive list of medications that have been examined in children with pervasive developmental disorders (PDDs) – albeit with varying degrees of rigor. These include antipsychotics, such as haloperidol and risperidone, alpha-2 agonists, such as clonidine and guanfacine, methylphenidate, antidepressants and the gastrointestinal hormone, secretin. In addition, medication such as fenfluramine, amantadine, and naltrexone has been examined in at least one study. To date, the best-studied medication in children with PDD is secretin, which has been examined in approximately 13 placebo-controlled trials (Levy and Hyman 2005). It has yet to show superiority to placebo. Although several medications have been evaluated for treatment of children with PDD, only a handful of trials have included more than 40 subjects. Over the past decade, however, evidence has emerged on the use of risperidone, the selective serotonin reuptake inhibitors (SSRIs), fluoxetine and citalopram, and methylphenidate in children with PDDs. Coincidently, these three classes of medication are also among the most commonly used in this population (Aman et al. 2003; Oswald and Sonenklar 2007; Mandell et al. 2008). This chapter reviews results from recently published reports mostly from federally-funded, multi-site randomized clinical trials. The review is organized according to target symptoms for medication intervention in children with PDDs, such as hyperactivity and impulsiveness, repetitive behavior, and the triad seriously maladaptive behavior: tantrums, aggression, and self-injury.
Keywords
- Attention Deficit Hyperactivity Disorder
- Repetitive Behavior
- Parent Training
- Pervasive Developmental Disorder
- Combine Treatment Group
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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- ADHD:
-
Attention deficit hyperactivity disorder
- CARS:
-
Childhood Autism Rating Scale
- CGI-I:
-
Clinical global impression-Improvement
- CYBOCS:
-
Children’s Yale-Brown Obsessive–Compulsive Scale
- DSM-IV-TR:
-
Diagnostic and Statistical Manual of Mental Disorders, 4th edition
- FDA:
-
Food and Drug Administration
- HSQ:
-
Home Situations Questionnaire
- OCD:
-
Obsessive–compulsive disorder
- PDD:
-
Pervasive developmental disorder
- PDD-NOS:
-
Pervasive developmental disorder, not otherwise specified
- RUPP:
-
Research Units on Pediatric Psychopharmacology
- SSRI:
-
Selective serotonin reuptake inhibitor
- STAART:
-
Studies to Advance Autism Research and Treatment
References
Aman, M. G., Lam, K., & Collier-Crespin, A. (2003). Prevalence and patterns of use of psychoactive medicines among individuals with autism in the autism society of Ohio. Journal of Autism and Developmental Disorders, 33(5), 527–534.
Aman, M. G., McDougle, C. J., Scahill, L., Handen, B., Arnold, L. E., et al. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavioral problems: Results from a randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(12), 1143–1154.
APA. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. – text revision). Washington, DC: American Psychiatric Association.
Biederman, J., Melmed, R. D., Patel, A., et al. (2008). A randomized, double-blind, placebo-controlled study of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics, 121(1), e73–e84.
Brown, E., Aman, M., & Havercamp, S. (2002). Factor analysis and norms for parent ratings on the Aberrant Behavior Checklist-Community for young people in special education. Research in Developmental Disabilities, 23, 45–60.
Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C., & Eyberg, S. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample. Assessment, 15(3), 317–328.
Campbell, M., Anderson, L., & Cohen, I. (1982). Haloperidol in autistic children: Effects on learning, behavior, and abnormal involuntary movements. Psychopharmacology Bulletin, 18(1), 110–111.
Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry, 66(Suppl. 10), 3–8.
Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology, revised. Rockville, MD: National Institute of Mental Health. on p. 243
Handen, B. L., Sahl, R., & Hardan, A. Y. (2008). Guanfacine in children with autism and/or intellectual disabilities. Journal of Developmental and Behavioral Pediatrics, 29(4), 303–308.
Hollander, E., Phillips, A., Chaplin, W., Zagursky, K., Novotny, S., & Wasserman, S. (2005). A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology, 30(3), 582–589.
Horrigan, J. P., & Barnhill, L. J. (1995). Guanfacine for treatment of attention-deficit hyperactivity disorder in boys. Journal of Child and Adolescent Psychopharmacology, 5(3), 215–223.
Jaselskis, C., Cook, E., Fletcher, K., & Leventhal, B. L. (1992). Clonidine treatment of hyperactive and impulsive children with autistic disorder. Journal of Clinical Psychopharmacology, 12, 322–327.
Johnson, C. R., Handen, B. L., Butter, E., Wagner, A., Mulick, J., & Sukhodolsky, D. G. (2007). Development of a parent management training program for children with pervasive developmental disorders. Behavioral Interventions, 22, 1–21.
King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: Citalopram ineffective in children with autism. Archives of General Psychiatry, 66(6), 583–590.
Kolevzon, A., Mathewson, K., & Hollander, E. (2006). Selective serotonin reuptake inhibitors in autism: A review of efficacy and tolerability. Journal of Clinical Psychiatry, 67, 407–414.
Levy, S., & Hyman, S. (2005). Novel treatments for autistic spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 11, 131–142.
Luby, J., Mrakotsky, C., Salets, M., Belden, A., Heffelfinger, A., & Williams, M. (2006). Risperidone in preschool children with autistic disorders: An investigation of safety and efficacy. Journal of Child and Adolescent Psychopharmacology, 16(5), 575–587.
Mandell, D. S., Morales, K. H., Marcus, S. C., Stahmer, A. C., Doshi, J., & Polsky, D. E. (2008). Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics, 121(3), e441–448.
McDougle, C. J., Scahill, L., Aman, M. G., McCracken, J. T., Tierney, E., et al. (2005). Risperidone for the core symptom domains of autism: Results from the RUPP Autism Network study. American Journal of Psychiatry, 162, 1142–1148.
MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086.
Neuropharm Group. (2009). Phase III SOFIA study of NPL-2008 in Autistic Disorder. Retrieved August, 2009 from http://www.neuropharm.co.uk/media_centre/news_release/?page=2&id=3542
Oswald, D. P., & Sonenklar, N. A. (2007). Medication use among children with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 17(3), 348–355.
Posey, D., Aman, M., McCracken, J., Scahill, L., Tierney, E., et al. (2007). Positive effects of methylphenidate on inattention and hyperactivity in pervasive developmental disorders: An analysis of secondary measures. Biological Psychiatry, 61(4), 538–544.
RUPP. (2002). Risperidone in children with autism and serious behavioral problems. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. New England Journal of Medicine, 347(5), 314–321.
RUPP. (2005a). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. Archives of General Psychiatry, 62(11), 1266–1274.
RUPP. (2005b). Risperidone treatment of autistic disorder: longer term benefits and blinded discontinuation after six months. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. American Journal of Psychiatry, 162, 1361–1369.
RUPP. (2007). A pilot study of parent management training in children with pervasive developmental disorder. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. Behavioral Interventions, 22, 179–199.
Scahill, L., & Martin, A. (2005). Psychopharmacology. In F. R. Volkmar, R. Paul, A. Klin, & D. J. Cohen (Eds.), Handbook of Autism and Pervasive Developmental Disorders (3rd ed., pp. 1102–1117). Hoboken, NJ: Wiley.
Scahill, L., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., et al. (2006). A prospective open trial of guanfacine in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 16(5), 589–598.
Scahill, L., Aman, M., McDougle, C., Arnold, L., McCracken, J., & Handen, B. (2009). Trial design challenges when combining medication and parent training in children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 39(5), 720–729.
Scahill, L., Chappell, P. B., Kim, Y. S., Schultz, R. T., Katsovich, L., et al. (2001). A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. American Journal of Psychiatry, 158(7), 1067–1074.
Scahill, L., McDougle, C. J., Williams, S. K., Dimitropoulos, A., Aman, M. G., et al. (2006). Children’s Yale-Brown obsessive compulsive scale modified for pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45(9), 1114–1123.
Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., et al. (1997). Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(6), 844–852.
Shea, S., Turgay, A., Carroll, A., Schulz, M., Orlik, H., et al. (2004). Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics, 114(5), e634–e641.
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Scahill, L., Boorin, S.G. (2011). Psychopharmacology in Children with PDD: Review of Current Evidence. In: Reichow, B., Doehring, P., Cicchetti, D., Volkmar, F. (eds) Evidence-Based Practices and Treatments for Children with Autism. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-6975-0_8
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