Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial
| Autor: | Roumen Nikolov, Stacie L. Pozdol, Yaser Ramadan, L. Eugene Arnold, Jill A. Hollway, Louise Ritz, Eric Butter, Naomi B. Swiezy, Karen Bearss, Allison Gavaletz, Stacie Trollinger, Kimberly A. Stigler, Kathleen Koenig, Ann Wagner, Lawrence Scahill, Michael G. Aman, Patricia Korzekwa, Sunkyung Yu, Christopher J. McDougle, Arlene E. Kohn, Luc Lecavalier, Denis D. Sukhodolsky, Benjamin L. Handen, Cynthia R. Johnson, Kristy L. Hall, James Dziura, James A. Mulick, Benedetto Vitiello |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Child Development Disorders aripiprazole autistic disorder parent management training pervasive developmental disorders risperidone Adolescent Antipsychotic Agents Behavior Therapy Child Child Behavior Disorders Child Development Disorders Pervasive Child Preschool Combined Modality Therapy Dose-Response Relationship Drug Double-Blind Method Female Humans Personality Assessment Psychometrics Risperidone Education Developmental and Educational Psychology Psychiatry and Mental Health medicine.drug_class Atypical antipsychotic Irritability Article law.invention Dose-Response Relationship Randomized controlled trial law Pervasive developmental disorder medicine Psychiatry Preschool Pervasive medicine.disease Developmental disorder Parent training Aripiprazole medicine.symptom Drug Psychology medicine.drug |
| Zdroj: | Journal of the American Academy of Child and Adolescent Psychiatry. 48(12) |
| ISSN: | 1527-5418 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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