Child and Adolescent Psychiatric Clinics of North America
Pharmacotherapy of Irritability in Pervasive Developmental Disorders
Section snippets
Typical antipsychotics
Research into the pharmacotherapy of autism and related disorders began in the 1960s. The development of the typical antipsychotic chlorpromazine for schizophrenia led to the dawn of a new era in psychiatry based on the pharmacologic treatment of psychiatric disorders. Over time as more compounds were developed investigators actively sought to determine their potential use in targeting the severe and often debilitating symptoms of aggression and SIB in autism; however, these studies were
Clonidine
A 6-week double-blind, placebo-controlled crossover study of clonidine was conducted in eight children and adolescents aged 5 to 13 years (mean, 8.1 years) with autism [41]. Treatment at doses ranging from 4 to 10 μg/kg/d led to significant improvement of irritability, hyperactivity, stereotypies, inappropriate speech, and oppositional behavior according to parent and teacher ratings on the ABC and Connors scales; however, the investigators did not record any significant changes. Adverse
Summary
Research to date supports use of the atypical antipsychotics as a first-line pharmacologic treatment for children and adolescents with PDDs and associated irritability (aggression, SIB, tantrums). Indeed, the only medication treatment currently approved for irritability in youth with autism is risperidone. Other atypical antipsychotics, including olanzapine and aripiprazole, are currently being investigated via double-blind, placebo-controlled trials. In addition to ongoing research on the
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Why pharmacotherapy is overused among persons with Autism Spectrum Disorders
2015, Research in Autism Spectrum DisordersAutism Spectrum Disorders: Clinical Considerations
2014, Rosenberg's Molecular and Genetic Basis of Neurological and Psychiatric Disease: Fifth EditionThe relationship between cognitive development and conduct problems in young children with autism spectrum disorder
2014, Research in Autism Spectrum DisordersConcurrent reductions in psychotropic medication, assault, and physical restraint in two residential treatment programs for youth
2013, Children and Youth Services ReviewCitation Excerpt :Several studies have indicated that psychotropic medications have effectively reduced mental health and behavioral symptoms. For example, research on the use of psychostimulants for youth with ADHD has demonstrated their effectiveness in reducing symptoms with moderate to large effects (Schachter, Pham, King, Langford, & Moher, 2001); positive effects also have been found when medications and psychosocial treatments were combined for youth with depression (March, Silva, Vitiello, & The TADS Team, 2006; Vitiello et al., 2006); and second generation antipsychotics have been effective for youth with behavioral disturbances and cognitive delay or autism spectrum disorders (Stigler & McDougle, 2008; Van Bellinghen & De Troch, 2001). These research gains showing positive effects of some psychotropic medications for specific target populations or clinical symptoms have been associated with the exponential growth in the popularity of these medications for aggressive behaviors in youth (Najjar et al., 2004; Naylor et al., 2007).
Management of Pediatric Patients With Autistic Spectrum Disorders in the Emergency Department
2013, Clinical Pediatric Emergency MedicineYouth at entry to residential treatment: Understanding psychotropic medication use
2012, Children and Youth Services ReviewCitation Excerpt :For youth with depression, selective serotonin reuptake inhibitors have been shown to be more effective than usual care when used either alone or in combination with psychosocial treatments (March, Silva, Vitiello, & The TADS Team, 2006). In addition, second generation antipsychotics have been shown to reduce levels of aggression for youth with both developmental delays and autism spectrum disorders (Stigler & McDougle, 2008; Van Bellinghen & De Troch, 2001). However, despite emerging evidence for the effectiveness of some psychotropic medications, widespread and frequent use of psychotropic medications for pediatric populations remains a controversial issue (Correll et al., 2006; Vitiello, 2007).
This work was supported in part by a Research Unit on Pediatric Psychopharmacology-Psychosocial Intervention grant (U10 MH066766) from the National Institute of Mental Health (NIMH) to Indiana University (Drs. McDougle and Stigler), research grant (R01 MH072964) from the NIMH (Drs. McDougle and Stigler), a General Clinical Research Center grant (M01 RR00750) from the National Institutes of Health to Indiana University (Drs. McDougle and Stigler), and a Daniel X. and Mary Freedman Psychiatric Research Fellowship Award (Dr. Stigler).