Combining medication and behav- ioral therapy leads to better outcomes for children with pervasive developmental disorders (PDDs), according to a recent study. Pervasive developmental disorder (PDD) is an umbrella diagnostic category that includes autism, Asperger’s syndrome, and pervasive developmental disorder-not otherwise specified (PDD–NOS). (For a basic review of PDD, see “Citalopram Not Effective for Autism in Children,” TCPR July/August 2009.) Clinicians often use risperidone to treat the aggression, tantrums and other behav- ioral issues that are common with PDD patients.This study was the first to look at whether adding behavioraltreatment to medication would improve outcomes. One hundred and twenty four children, ages 4 through 13, with PDDs and significant irritable behavior were randomly assigned either risperidone or risperidone + behavioral therapy. Risperidone was dosed according to weight and titrated to a potential maximum dose of 3.5 mg/day. Up to 17 sessions of highly structured behavioral therapy were offered by trained master’s or doctoral level therapists over 24 weeks. During therapy, patients’ parents were taught positive reinforcement, compliance, functional skills, and social skills. At the end of the study, the combined treatment group had statistically significantly higher rates of improvement on the Home Situations Questionnaire (which measures problem behaviors); and on rating scales of irritability, hyperactivity/noncompliance; and on one of two scales of repetitive behavior. There was no difference between treatments on social withdrawal or inappropriate speech.The most notable side effect was weight gain; mean BMI increased from 67th percentile to 84th percentile over 24 weeks.The combined group’s medication dose was 14% lower than the risperidone-only group, indicating that adding behavior therapy might allow physicians to moderate antipsychotic dosing, with a potential improvement in side effects (Aman MG et al., J Am Acad Child Adolesc Psychiatry 2009;48:1143–1154).
TCPR’s Take: Adding behavioral treatment to risperidone decreases irritability in children with PDDs more than using risperidone alone.The effect is moderate, so it is a judgment call whether the extra time and expense that therapy requires is worth it in all cases.The researchers plan to make the manual and other behavioral treatment materials available for public use, which should help to disseminate the method more broadly.
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