Risperidone in Preschool Children with Autistic Spectrum Disorders: An Investigation of Safety and Efficacy
ABSTRACT Early intervention in autism spectrum disorders (ASDs) appears promising and may represent a window of opportunity for more effective treatment. Whereas the safety and efficacy of risperidone have been established for children aged 5 and older, they has not been adequately tested in preschool children.
A randomized placebo-controlled study of risperidone in preschool children was conducted in a sample of young children, most of whom were also undergoing intensive behavioral treatment.
Preschool children tolerated low-dose risperidone well with no serious adverse effects observed over a 6-month treatment period. Weight gain and hypersalivation were the most common side effects reported, and hyperprolactinemia without lactation or related signs was observed. Significant differences between groups found at baseline complicated the analyses; however, controlling for some of these differences revealed that preschoolers on risperidone demonstrated greater improvements in autism severity. The change in autism severity scores from baseline to 6-month follow up for the risperidone group was 8% compared to 3% for the placebo group. Notably, both groups significantly improved over the 6-month treatment period.
Study findings suggest that risperidone is well tolerated in preschoolers over a 6-month period, but that only minimally greater improvement in target symptoms was evident in the risperidone group, possibly due to the differences between groups at baseline or due to the small sample size. Although these findings are not sufficient to direct treatment, they suggest that larger-scale, double-blind, placebo-controlled investigations of risperidone in preschoolers with ASDs should now be conducted.
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- "Divalproex sodium (834 mg/j vs placebo 7 vs 6 9 ans              8 semaines CY-BOCS Divalproex > placebo (p = 0,037) Bonne tolérance. Hellings et al., 2005  Valproate (75,5 mcg/mL) vs placebo 16 vs 14 12,1 ans                8 semaines CGI ABC-i OAS Pas de différence significative Effets secondaires : augmentation de l'appétit, rash cutané Wasserman et al., 2006  Levetiracétam 10 vs 10 5 à 17 ans 10 semaines CGI ABC CY-BOCS Levetiracétam = placebo Belsito et al., 2001  Lamotrigine (5 mg/kg) vs placebo 14 vs 14 5,8 ans [3–11] 18 semaines ABC et autres echelles (CARS, ADOS-PL, VABS) Lamotrigine = placebo CGI : clinical global impression ; CY-BOCS : Children Yale-Brown Obsessive-Compulsive Scale ; ABC : aberrant behaviour checklist. "
ABSTRACT: Global Management of autistic people primarily requires behavioral and educational therapy. There is actually no psychopharmacological agent that is efficient on the core symptoms of autism, especially the social and communicative impairments.However psychotropic medications are widely prescribed in this population and as mush as 1 out 2 people with autism receives at least one medication. In this population, medications are mainly directed at the frequently associated behavioral symptoms such as aggression toward self or others, tantrums, hyperactivity, severe repetitive behaviors. The goal of this article is to provide a review of the existing controlled studies in this area. The presented studies aim the following therapeutic classes: atypical antipsychotics, selective serotonin reuptake inhibitors (SSRI), psychostimulants and antiepileptics. The studies and there mains results in terms of efficiency and safety are presented in tables. Atypical antipsychotics, especially risperidone and aripiprazole have been shown to be useful in the treatment of behavioral symptoms. SSRI seem to have limited interest for the management of repetitive behaviors. Stimulants can help in case of hyperactivity and attention deficit associated with Autism spectrum disorders. Antiepileptics show promising results, but the best indications for this class are not clear. For sleep disturbances, melatonin can be a safe and efficient option.Challenging behaviors requires careful investigation to understand their origin in order to provide the specific management. The first answer should be environmental and educational .Somatic or mental diseases should be carefully assessed.Medication use in this vulnerable population should carefully evaluate the benefit/risk balance. Medications should be prescribed at the minimum dose for the minimum duration.Neuropsychiatrie de l Enfance et de l Adolescence 01/2012; DOI:10.1016/j.neurenf.2011.10.011
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- "Olfson, Huang, Pincus, & Gerhard, 2009). Deleterious side effects, specific to children and adolescents at critical stages of development, as well as gaps in research demonstrating the safety (Correll, 2008; Costa, Steardo, & Cuomo, 2004; DeVeaugh-Geiss et al., 2006; Greenhill , Vitiello, & Riddle, 2003; Jensen et al., 1999; Luby et al., 2006; Olfson, Crystal, Huang, & Gerhard, 2010; Safer & Zito, 2006; Zima et al., 1999a; Zito, Socolar, Eilers, Crystal, & Lexchin, 2007; Zito, Safer et al., 2008) of psychotropic agents suggest the need for careful, researchinformed prescription and monitoring practices in what we have called the medication grid (Longhofer, Floersch, & Jenkins, 2003). "
ABSTRACT: Foster care children are prescribed psychotropic medications at rates significantly higher than same-aged peers. Concerns about the safety of psychoactive chemicals on developing bodies and potential misuses with foster care populations have led to varied and complex responses by the media, lawmakers, and researchers. First, we look at how foster youth are prescribed psychoactive substances, including polypharmacy (sometimes called concomitant prescription), and at the mounting and major responses by federal and state governments. Second, we consider a recent parameter published by the American Academy of Child and Adolescent Psychiatry. Third, we consider how foster care settings, what we call open systems, complicate parameter implementation, creating potential gaps among researcher, prescriber, foster caregivers, and youth medication explanatory models of treatment experience. And finally, to address gaps among researcher, prescriber, and patient explanatory models, we propose the use of arbitrage, a conceptual framework and process for the integration of competing and sometimes incommensurable explanatory models, knowledge and practice claims.Children and Youth Services Review 02/2011; 33(2):395-404. DOI:10.1016/j.childyouth.2010.10.006 · 1.27 Impact Factor
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ABSTRACT: Autism and the related pervasive developmental disorders (PDDs) are characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills, which arise in the first years of life. In 1943 Dr. Leo Kanner studied a group of 11 children manifesting with unusual symptoms of aloofness and odd behaviour with areas of exceptional development .These children were apparently in a world of their own and to this disorder the name infantile autism was given. Kanner's classic description still holds good today and children with autism still manifest the same symptom triad of impaired social relatedness, and communication with a restricted repertoire of behaviour. The pervasive developmental disorders, or autism spectrum disorders, range from a severe form, called autistic disorder, to a milder form, Asperger syndrome. Other rare, very severe disorders that are included in the autism spectrum disorders are Rett's syndrome and childhood disintegrative disorder.. The following aspects of the disorder will be considered