Children with autism spectrum disorders who also have serious behavioral problems responded better to medication combined with training for their parents than to treatment with medication alone, Yale researchers and their colleagues report in the February issue of Journal of the American Academy of Child & Adolescent Psychiatry.
"Serious behavioral problems interfere with everyday living for children and their families," said senior author on the study Lawrence Scahill, professor at Yale University School of Nursing and the Child Study Center. "Decreasing these serious behavioral problems results in children who are more able to manage everyday living."
Scahill and his team completed a federally funded multi-site trial on 124 children ages 4 to 13 with autism spectrum disorders at three U.S. sites including Yale, Ohio State University, and Indiana University. In addition to autism spectrum disorders, children in the study had serious behavioral problems, including multiple and prolonged tantrums, aggression, and/or self-injurious behavior on a daily basis.
The children in the study were randomly assigned to medication alone for six months or medication plus a structured training program for their parents for six months. Parent training included regular visits to the clinic to teach parents how to respond to behavior problems to help children adapt to daily living situations. The study medication, risperidone, is approved for the treatment of serious behavioral problems in children with autism.
"In a previous report from this trial, we showed that the combined treatment was superior to medication alone in reducing the serious behavioral problems," said Scahill. "In the current report, we show that combination treatment was better than medication alone on measures of adaptive behavior. We note that both groupsómedication alone and combined treatment groupódemonstrated improvement in functional communication and social interaction. But the combined group showed greater improvement on several measures of everyday adaptive functioning."
Based on these findings, Scahill and his team are now conducting a study that uses parent training as a stand-alone strategy in treating younger children with autism spectrum disorders. This study is being conducted at Yale and four other medical centers across the country. The investigators also plan to publish the parent training manuals as a way to share this intervention with the public.
Other authors on the study included Christopher J. McDougle, Michael G. Aman, Cynthia Johnson, Benjamin Handen, Karen Bearss, James Dziura, Eric Butter, Naomi G. Swiezy, L. Eugene Arnold, Kimberly A. Stigler, Denis D. Sukhodolsky, Luc Lecavalier, Stacie L. Pozdol, Roumen Nikolov, Jill A. Hollway, Patricia Korzekwa, Allison Gavaletz, Arlene E. Kohn, Kathleen Koenig, Stacie Grinnon, James A. Mulick, Sunkyung Yu, and Benedetto Vitiello.
The National Institute of Mental Health funded the study. The work was also funded, in part, by the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Research Resources at the National Institutes of Health.
Citation: J. Am. Acad. Child Adolesc. Psychiatry, Vol. 51, No. 2 (February 2012)
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