Medicinering og forældretræning af børn med gennemgribende udviklingsforstyrrelser og alvorlig problemadfærd. Resultater fra et randomiseret klinisk forsøg

Kategori: Gruppestudier

To tilfældigt fordelte grupper af børn med autisme sammenlignes: den ene gruppe blev kun medicineret med Risperdal, mens den anden gruppe fik en kombination af Risperdal og ABA-behandling i hjemmet. Efter seks måneder kunne forskerne konstatere en mindsket problemadfærd hos begge grupper af børn, men forbedringerne var markant større blandt de børn, der havde fået kombinationsbehandlingen. Deres irritabilitet, overfølsomhed, raserianfald og impulsivitet var betydelig mindre end hos de børn, der kun blev medicineret. Desuden var deres medicinforbrug mindre.

Emneord: © 2011 ABAforum

Aman, M.G., C.J. McDougle, L. Scahill, B. Handen, L.E. Arnold, C. Johnson, K.A. Stigler, K. Bearss, E. Butter, N.B. Swiezy, D.D. Sukhodolsky, Y. Ramadan, S.L. Pozdol, R. Nikolov, L. Lecavalier, A.E. K (2009). Medication and Parent Training in Children With Pervasive Developmental Disorders and Serious Behavior Problems: Results From a Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(12), 1143-1154.

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.

Redaktionen / 26.11.2009