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Query: UMLS:C0004352 (autism)
 32,579 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Open clinical treatment with risperidone was administered to a clinically heterogeneous group of 11 children and adolescents (age range 5.5-16 years, mean 9.8 years) with concurrent presentation of affective symptoms (mostly suggestive of bipolar disorder), aggressive and violent behavior, and marked management problems. These patients had responded inadequately to several mood-stabilizing medications. In this outpatient sample, 8 of 11 children (73%) appeared to have therapeutic responses to risperidone. Risperidone doses were low (0.75-2.5 mg daily) and clinical responses were observed at times within days of receiving the medication. Improvement was clinically judged to be moderate to marked in 7 of 8 children. In addition, the treatment of 2 children was stopped because of drowsiness; one also experienced a weight gain of 6 kg (13 lbs). An additional child with autism and aggressive behavior who lacked affective symptoms did not respond to risperidone. None of the children showed behavioral deterioration. Seven of the 8 responders were taking concurrent medications; including 4 on mood-stabilizing medications (either lithium, carbamazepine, or valproic acid) in subtherapeutic doses. Even in combination with other medications, side effects at these doses were minimal and limited to mild sedation and, at times, troubling weight gain. Pending controlled studies, these preliminary findings suggest that risperidone--alone or in combination with mood stabilizers--may be of value in treating children and adolescents with mood disorders (especially subthreshold bipolar disorder) and aggressive behavior.
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PMID:Risperidone for young children with mood disorders and aggressive behavior. 963 79

Risperidone has proven efficacy with reduced likelihood of causing extrapyramidal symptoms in the treatment of schizophrenia. Initial work suggests its utility in the management of aggression and self injury in patients with mental retardation. The use of risperidone in eight adult patients with moderate to profound mental retardation is described. Risperidone in these individuals was associated with significant reduction in aggression and self injurious behavior. Side effects were primarily those of sedation and restlessness. These cases illustrate the possible utility of risperidone in the treatment of aggression and self injury in adult patients with moderate to profound mental retardation.
J Autism Dev Disord 1998 Jun
PMID:Risperidone for aggression and self-injurious behavior in adults with mental retardation. 965 34

In this study, we examined three maladaptive behaviors, self-injurious behavior (SIB), stereotypies, and aggression in adults with autism, pervasive developmental disorder, not otherwise specified (PDD-NOS), and mental retardation. We used a brief functional analysis rating scale. The Questions About Behavioral Functions (QABF), to examine the function of each behavior. Across the three groups, our results indicated that aggression was primarily maintained for attentional reasons and stereotypies for nonsocial reasons. No specific function(s) were found to maintain SIB. These results suggest that the function of a maladaptive behavior may be associated more with the particular maladaptive behavior displayed rather than inclusion in a certain diagnostic group. Implications of findings for assessment and treatment issues are discussed.
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PMID:An analysis of maladaptive behaviors in persons with autism, PDD-NOS, and mental retardation. 977 Feb 55

This pilot study examined the efficacy and tolerability of olanzapine in the treatment of children, adolescents, and adults with pervasive developmental disorders (PDDs). Eight patients with principal diagnoses (DSM-IV) of autistic disorder (N = 5) or PDD not otherwise specified (N = 3) were given olanzapine in an open-label, prospective fashion for 12 weeks. Clinical ratings were obtained at baseline and at the end of weeks (EOWs) 4, 8, and 12. Seven of eight patients completed the 12-week trial, and six of the completers were deemed clinical responders as measured by ratings at the EOW 12 of "much improved" or "very much improved" on the global improvement item of the Clinical Global Impression Scale. Significant improvements in overall symptoms of autism, motor restlessness or hyperactivity, social relatedness, affectual reactions, sensory responses, language usage, self-injurious behavior, aggression, irritability or anger, anxiety, and depression were observed. Significant changes in repetitive behaviors were not observed for the group. The EOW 12 mean +/- SD daily dose of olanzapine was 7.8 +/- 4.7 mg/day. The drug was well tolerated with the most significant adverse effects noted to be increased appetite and weight gain in six patients and sedation in three. With respect to weight gain, the mean +/- SD weight for the group increased from 137.50 +/- 55.81 pounds (62.50 +/- 25.37 kilograms) at baseline to 155.94 +/- 55.13 pounds (70.88 +/- 25.06 kilograms) at EOW 12. No evidence of extrapyramidal side effects or liver function abnormalities was seen. These preliminary results suggest that olanzapine may be an effective and well tolerated drug in targeting core and related symptoms of PDDs in children, adolescents, and adults. Further studies, particularly those that are placebo-controlled and double-blinded, are indicated to better define the clinical use of olanzapine in these patient populations.
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PMID:Olanzapine treatment of children, adolescents, and adults with pervasive developmental disorders: an open-label pilot study. 1127 Sep 29

Children with autism and the related PDDs may benefit from serotonin reuptake inhibitors such as clomipramine, fluoxetine, fluvoxamine, and sertraline for targeting repetitive thoughts and behaviors, anxiety, and depressed mood. To date, however, there are few controlled studies of these agents in children with PDD, so definitive evidence is lacking. Despite preliminary results in favor of naltrexone, neuroleptic medication appears to be effective for reducing aggression, self-injurious behavior, agitation, and stereotypies. The primary drawback with traditional neuroleptics is risk of short- and long-term side effects. The newer atypical neuroleptics have the potential for benefit with fewer extrapyramidal side effects, but more study is needed to establish their efficacy and safety. Children on neuroleptic medications should be started at the lowest possible dose, with gradual increases until clinical benefit is observed. The likelihood of untoward side effects is increased if the medication dose is increased rapidly. Baseline measurement of target behaviors can be aided by using standardized scales. The presence of abnormal movements should be assessed before initiating treatment and at regular intervals during the course of treatment--including after medication withdrawal. Weight gain is emerging as a recurrent side effect with the atypical neuroleptics. Thus, weight should be monitored, and the family should be advised about a diet baseline. As with all treatments of children with severe behavioral difficulties, pharmacotherapy should be instituted in the context of an integrated treatment plan.
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PMID:Pharmacotherapy in children and adolescents with pervasive developmental disorders. 1034 30

Autism can be considered as an early general developmental disorder, characterized by problems of social interaction, problems of verbal and non verbal communication, and behavioral or ideational stereotypes. However, within autism we observe a clinical heterogeneity of autistic disorders which suggests the possibility of autistic subtypes. Several authors hypothesize an analgesia among autistic children; this analgesia may be related to self-mutilation found among autistics. The current research had two objectives: 1) to develop and validate evaluation tools for measuring aggression directed towards the self (Yale-Paris Self-Injurious Behavior Scale: YAPA SIB) and pain reactivity (Pre-Linguistic Behavioral Pain Reactivity Scale: PLBPRS); instruments appropriate for autistics and capable of showing different behavioral sub-types; 2) to study in 80 autistic children pain reactivity, self-injurious behavior, and their relation in different observational situations. The results show that the scales of self-injurious behavior and pain reactivity have good discriminative capacity, good test-retest reliability, and good validity. The results suggest additionally that the apparent decreased pain reactivity observed in autistics does not derive from a real analgesia but from a different mode of pain expression related to difficulties with verbal communication, body representation and certain cognitive disorders (learning disorders, problems representing sensations and emotions, problems establishing cause-effect relationships). Additionally, there is a significant relationship between certain self-injurious behaviors and the apparent reduced pain reactivity. Interpretations of this result are presented and the possible role of stress in autism is discussed.
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PMID:[Study of the relationships between self-injurious behavior and pain reactivity in infantile autism]. 1037 Aug 85

An 8-year-old boy with cystic fibrosis (CF), mental retardation, and autism exhibited noncompliance with respiratory treatments that were essential for the management of his CF. A treatment involving shaping cooperation while still allowing escape for aggression and avoidance behavior resulted in increases compliance with respiratory treatments and decreases in problem behavior. Treatment gains were maintained over 3 months.
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PMID:Reinforcement of compliance with respiratory treatment in a child with cystic fibrosis. 1039 78

This report describes the use of risperidone in the treatment of two very young children with autistic disorder, a 29-month-old boy and a 23-month-old boy, respectively. These children presented with severe and persistent symptoms of aggression and irritability that had not responded to previous treatment. In both cases, risperidone significantly reduced aggression and improved social relatedness. One patient's treatment with risperidone was complicated by persistent tachycardia and QTc interval prolongation that was dose-related. Consideration should be given to the appropriate use of medication in the treatment of very young children with autism when other interventions do not prove helpful.
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PMID:Risperidone in the treatment of two very young children with autism. 1063 Apr 57

This article has reviewed the background and rationale for the choice of risperidone as the first drug to be studied by the RUPP Autism Network. Risperidone has potent effects on 5-HT and DA neuronal systems, both of which have been implicated in the pathophysiology of autism. Unlike the typical antipsychotics, haloperidol and pimozide, which have been shown to be effective for reducing many of the maladaptive behaviors associated with autism, risperidone's 5-HT2A/DA D2 ratio of receptor blockade appears to produce a lower risk of acute and chronic extrapyramidal side effects, as well as enhanced efficacy for the "negative" symptoms of autism. Indirect clinical and preclinical evidence supports the use of risperidone to treat impaired social behavior, interfering repetitive phenomena, and aggression, targets of pharmacotherapy for many patients with autism. Numerous published open-label trials in children and adolescents with autism and related PDDs and one double-blind, placebo-controlled study in adults suggest that risperidone has promise for the treatment of children and adolescents with autism. Because most of these studies have been short-term, open-label trials in small samples, however, a large-scale controlled study of risperidone in children and adolescents with autism is needed to confirm these results. Finally, because it is likely that children who demonstrate short-term benefit from risperidone will remain on the medication indefinitely, the longer-term effectiveness and safety of risperidone in this population also needs to be determined. The design of this study and the assessments used are described separately.
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PMID:Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. Background and rationale for an initial controlled study of risperidone. 1067 97

Repetitive thoughts and behavior are considered integral and core components of autistic disorder. Results from recent studies suggest that the types of repetitive thoughts and behavior of adults with autism and those with obsessive-compulsive disorder (OCD) may be different. Serotonin reuptake inhibitors (SRIs), the primary drug treatment for patients with OCD, may reduce the repetitive phenomena of some autistic patients. Two controlled studies of the nonselective SRI clomipramine have shown the drug to be more efficacious than the relatively selective norepinephrine reuptake inhibitor desipramine and placebo in children with autism. One controlled study of the selective SRI fluvoxamine found it to be significantly better than placebo for reducing repetitive phenomena and aggression in adults with autistic disorder. Additional research is needed.
J Autism Dev Disord 2000 Oct
PMID:Repetitive thoughts and behavior in pervasive developmental disorders: treatment with serotonin reuptake inhibitors. 1109 79


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