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Saima S, Ihara H, Ogata H, Gito M, Murakami N, Oto Y, Ishii A, Takahashi A, Nagai T. Relationship Between Sensory Processing and Autism Spectrum Disorder-Like Behaviors in Prader-Willi Syndrome. Am J Intellect Dev Disabil 2022; 127:249-263. [PMID: 35443050 DOI: 10.1352/1944-7558-127.3.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/20/2021] [Indexed: 06/14/2023]
Abstract
The relationship between sensory processing and ASD-like and associated behaviors in patients with Prader-Willi Syndrome (PWS) remains relatively unexplored. Examining this relationship, 51 adults with PWS were administered the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS), Short Sensory Profile (SSP-J), Food-Related Problem Questionnaire (FRPQ), and Aberrant Behavior Checklist (ABC-J). Based on SSP-J z-scores, participants were classified into three severity groups. Analysis of variance was performed to compare the behavioral scores of these three groups. Statistically significant group differences were observed in PARS (p = .006, ηp2 = .194) and ABC-J (p = .006, ηp2 = .193) scores. Our findings suggest that the level of sensory processing may predict ASD-like and aberrant behaviors in adults with PWS, implying the importance of a proper assessment for early intervention.
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Affiliation(s)
- Sohei Saima
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Hiroshi Ihara
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Hiroyuki Ogata
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Masao Gito
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Nobuyuki Murakami
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yuji Oto
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Atsushi Ishii
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Asami Takahashi
- Sohei Saima, Hiroshi Ihara, Hiroyuki Ogata, Masao Gito, Nobuyuki Murakami, Yuji Oto, Atsushi Ishii, and Asami Takahashi, Dokkyo Medical University Saitama Medical Center, Japan
| | - Toshiro Nagai
- Toshiro Nagai, Nakagawanosato Ryoiku Center, Japan. Sohei Saima and Hiroshi Ihara contributed equally to this article
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van den Bogaard KJHM, Nijman HLI, Palmstierna T, Embregts PJCM. Self-Injurious Behavior in People with Intellectual Disabilities and Co-Occurring Psychopathology using the Self-Harm Scale: A Pilot Study. J Dev Phys Disabil 2018; 30:707-722. [PMID: 30220833 PMCID: PMC6132616 DOI: 10.1007/s10882-018-9614-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Self-injurious behavior (SIB) is one of the most detrimental behaviors for the person showing it, as well as for their environment. Nevertheless, structured clinical assessments of SIB are scarce. Staff completed a Self-Harm Scale (SHS) every time they witnessed SIB in clients with an intellectual disability (ID) and co-occurring psychopathology (N = 33). Descriptive statistics were conducted to explore the nature of the incidents of SIB and the characteristics of the people involved in the incidents. In 41 weeks, 104 SIB incidents were reported for 8 out of 33 clients (24%). Incidents were most prevalent on Mondays (23%). As far as the methods of SIB concerned, cutting was the most used method (63%). Clients who showed SIB differed significantly from clients who did not on gender, having a personality disorder and communicative abilities. This study was one of the few that used an incident-based record form to report SIB by direct observation. It is hoped that the SHS helps to gain more information about SIB, to improve individualized interventions. Further research is necessary to determine the psychometric properties and clinical utility of the scale.
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Affiliation(s)
- Kim J. H. M. van den Bogaard
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Prof. Cobbenhagenlaan 125, 5037DB Tilburg, The Netherlands
- Dichterbij Science and Innovation, Gennep, The Netherlands
| | - Henk L. I. Nijman
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands
- Aventurijn – Fivoor, Forensic Psychiatric Institute, Den Dolder, The Netherlands
| | - Tom Palmstierna
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- St. Olav’s University Hospital, Center for Research and Education in Forensic Psychiatry, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Petri J. C. M. Embregts
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Prof. Cobbenhagenlaan 125, 5037DB Tilburg, The Netherlands
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Ishii A, Ihara H, Ogata H, Sayama M, Gito M, Murakami N, Ayabe T, Oto Y, Takahashi A, Nagai T. Autistic, Aberrant, and Food-Related Behaviors in Adolescents and Young Adults with Prader-Willi Syndrome: The Effects of Age and Genotype. Behav Neurol 2017; 2017:4615451. [PMID: 29440778 DOI: 10.1155/2017/4615451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
The effects of age and genotype were examined, with regard to the severity of aberrant, autistic, and food-related behaviors in Prader-Willi syndrome (PWS), with an emphasis on the contrast between adolescents and young adults. The Aberrant Behavior Checklist Japanese version (ABC-J), the Food Related Problem Questionnaire (FRPQ), and the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) were administered to 65 PWS patients, including 20 adolescents (ages 12 to 17) and 45 young adults (ages 18 to 29). Significant differences (Mann-Whitney U tests) were found in ABC-J (p = 0.004) and PARS (p = 0.021), with lower scores in adolescents than in young adults. While DEL subgroups showed no significant differences between the two age groups in ABC-J (p = 0.063) and PARS (p = 0.134), mUPD subgroups showed a statistically significant difference in terms of ABC-J (p = 0.007). No significant differences were found between adolescents and young adults, in terms of FRPQ (p = 0.163). These results suggest that aberrant and autistic behaviors follow a marked worsening trend from around the age of 18. On the other hand, food-related behaviors give no sign of change at this transitory stage. Young adults with mUPD were found to be significantly more severe than adolescents with mUPD, in terms of aberrant behaviors.
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Ogata H, Ihara H, Gito M, Sayama M, Murakami N, Ayabe T, Oto Y, Nagai T, Shimoda K. Aberrant, autistic, and food-related behaviors in adults with Prader-Willi syndrome. The comparison between young adults and adults. Res Dev Disabil 2018; 73:126-134. [PMID: 29324255 DOI: 10.1016/j.ridd.2017.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 06/07/2023]
Abstract
This study aims to explore the differences of age as well as genotype in regards to the severity of behavioral symptoms in Prader-Willi syndrome (PWS), with emphasis on the comparison between youngadults and adults.The Food Related Problem Questionnaire (FRPQ), the Aberrant Behavior Checklist Japanese Version (ABC-J), and the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) were administered to 46 PWS patients, including 33 young adults (ages 18-28) and 13 adults(ages 30-45). To examine the differences between young adults and adults, Mann-Whitney U tests were conducted. Statistically significant differences were found in ABC-J (p = .027) and PARS (p = .046), with higher scores in young adults than adults. Such differences between the two age groups were still true for the subgroups having a paternal chromosome 15q deletion (DEL) for ABC-J (p = .050) and part of PARS ("Problematic behavior"; p = .007). By contrast, there was no significant differences between young adults and adults regarding FRPQ (p = .65).These results suggest that aberrant behaviors decline from around the ages of thirty, in PWS patients in general and in DEL subgroups in particular, while food-related behaviors give no indication of diminishing in spite of developmental growth.
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Affiliation(s)
- Hiroyuki Ogata
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Ihara
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Masao Gito
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan; Department of Psychiatry, Ikezawa Hospital, Hanyu, Japan
| | - Masayuki Sayama
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Nobuyuki Murakami
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tadayuki Ayabe
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yuji Oto
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
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Gito M, Ihara H, Ogata H, Sayama M, Murakami N, Nagai T, Ayabe T, Oto Y, Shimoda K. Gender Differences in the Behavioral Symptom Severity of Prader-Willi Syndrome. Behav Neurol 2015; 2015:294127. [PMID: 26633919 DOI: 10.1155/2015/294127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/20/2015] [Indexed: 01/06/2023] Open
Abstract
Objectives. This study measured gender differences in Prader-Willi syndrome (PWS) in regard to the severity of behavioral symptoms. Methods. The Food Related Problem Questionnaire (FRPQ), the Aberrant Behavior Checklist Japanese Version, the Childhood Routines Inventory, the Pervasive Developmental Disorders Autism Society Japan Rating Scale, and Japanese ADHD-RS were administered to PWS patients (45 males aged 6 to 58 and 37 females aged 6 to 45). To examine the effects that gender and genotype have on the severity of each symptom, two-way ANOVAs were conducted. Results. Significant interactions were found only in regard to FRPQ scores, such as FRPQ total score (F(1, 78) = 8.43, p < 0.01). The FRPQ of male deletion (DEL) individuals was higher than that of female DEL and male mUPD. The FRPQ of male maternal uniparental disomy (mUPD) was lower than that of female mUPD. Conclusions. In terms of problem behaviors, routines, autistic behaviors, and hyperactivity, no significant differences were found. Food-related behaviors in DEL were more severe in males, although those in mUPD were less severe in males.
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Hustyi KM, Hall SS, Jo B, Lightbody AA, Reiss AL. Longitudinal trajectories of aberrant behavior in fragile X syndrome. Res Dev Disabil 2014; 35:2691-2701. [PMID: 25129200 PMCID: PMC4820327 DOI: 10.1016/j.ridd.2014.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/25/2014] [Accepted: 07/02/2014] [Indexed: 06/03/2023]
Abstract
The Aberrant Behavior Checklist-Community (ABC-C; Aman et al., 1995) has been increasingly adopted as a primary tool for measuring behavioral change in clinical trials for individuals with fragile X syndrome (FXS). To our knowledge, however, no study has documented the longitudinal trajectory of aberrant behaviors in individuals with FXS using the ABC-C. As part of a larger longitudinal study, we examined scores obtained on the ABC-C subscales for 124 children and adolescents (64 males, 60 females) with FXS who had two or more assessments (average interval between assessments was approximately 4 years). Concomitant changes in age-equivalent scores on the Vineland Adaptive Behavior Scales (VABS) were also examined. As expected for an X-linked genetic disorder, males with FXS obtained significantly higher scores on all subscales of the ABC-C and significantly lower age-equivalent scores on the VABS than females with FXS. In both males and females with FXS, scores on the Irritability/Agitation and Hyperactivity/Noncompliance subscales of the ABC-C decreased significantly with age, with little to no change occurring over time on the Lethargy/Social Withdrawal, Stereotypic Behavior, and Inappropriate Speech subscales. The decrease in scores on the Hyperactivity/Noncompliance domain was significantly greater for males than for females. In both males and females, age-equivalent scores on the VABS increased significantly over this developmental period. These results establish a basis upon which to evaluate long-term outcomes from intervention-based research. However, longitudinal direct observational studies are needed to establish whether the severity of problem behavior actually decreases over time in this population.
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Affiliation(s)
- Kristin M Hustyi
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States.
| | - Scott S Hall
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States.
| | - Booil Jo
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States.
| | - Amy A Lightbody
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States.
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States; Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States; Department of Pediatrics, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford CA 94305, United States.
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Abstract
Paraphilia is a psychiatric disease that has been difficult to cure. However, recently developed therapeutic methods hold promise. The patient was a 20-yr-old male with chief complaints of continuous masturbation, genital exposure, and aggressive behavior that started 2 yr ago. We administered leuprorelin 3.6 mg intramuscular injection per month, a depot gonadotrophin-releasing hormone analogue, to this patient who a severe mentally retardation with paraphilia. The clinical global impression (CGI)-severity, CGI-improvement and aberrant behavior checklist were performed. After one month, we observed significant improvement in symptoms, such as decreases of abnormal sexual behavior and sexual desire. The GnRH analogues are suggested to be used as an alternative or supplementary therapeutic method for sexual offenders after clinical studies.
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Affiliation(s)
- Woo Sung Park
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
| | - Kyung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Korea
| | - Yong Woo Jung
- Department of Pharmacy, College of Pharmacy, Korea University, Sejong, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Social Science, Dankook University, Cheonan, Korea
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González ML, Dixon DR, Rojahn J, Esbensen AJ, Matson JL, Terlonge C, Smith KR. The Behavior Problems Inventory: Reliability and Factor Validity in Institutionalized Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 2009. [DOI: 10.1111/j.1468-3148.2008.00429.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND The focus of this review is on methods that are currently being used to evaluate the behavioural effects of medication for individuals with intellectual disabilities. First we describe what has been identified as the ideal criteria for conducting clinical trials and how these criteria may be adapted to do less controlled evaluations. The central theme is a review of the biological measures (e.g. labs, drug levels), behavioural rating scales and direct observation measures that are often used to evaluate medication effects. Issues related to how the side effects of medication can affect behaviour will also be discussed. CONCLUSION The importance of encouraging communication and collaboration across all systems of care and the use of socially valid measures are discussed.
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Affiliation(s)
- J Zarcone
- University of Rochester Medical Center, Rochester, New York 14642, USA.
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Rojahn J, Bienstein P. [Self-injurious-behavior in children and adolescents with intellectual disabilities]. Z Kinder Jugendpsychiatr Psychother 2008; 35:411-22. [PMID: 18357971 DOI: 10.1024/1422-4917.35.6.411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
10% of the children and teenagers with intellectual disability develop self-injurious behavior during lifespan. The causes for this are investigated, often various and reach from learn-theoretical up to neurobiological conditions. The available work gives overview of the current state of research to the etiology, further factors of influence as well as the process of self-injurious behavior by intellectual disability. Beyond that current diagnostics procedures, standard of treatment of the last thirty years and their effectiveness are presented and discussed finally.
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Affiliation(s)
- Johannes Rojahn
- Center for Behavioral & Cognitive Development, George Mason University, USA
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Mayville EA. Psychotropic Medication Effects and Side Effects. Handbook of Assessment in Persons with Intellectual Disability. Elsevier; 2007. pp. 227-51. [DOI: 10.1016/s0074-7750(07)34007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Rojahn J, Whittaker K, Hoch TA, González ML. Assessment of Self‐Injurious and Aggressive Behavior. Handbook of Assessment in Persons with Intellectual Disability 2007. [DOI: 10.1016/s0074-7750(07)34009-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hellings JA, Zarcone JR, Reese RM, Valdovinos MG, Marquis JG, Fleming KK, Schroeder SR. A Crossover Study of Risperidone in Children, Adolescents and Adults with Mental Retardation. J Autism Dev Disord 2006; 36:401-11. [PMID: 16596465 DOI: 10.1007/s10803-006-0078-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Risperidone has shown safety and efficacy for aggressive and destructive behaviors in short-term studies. This longer-duration study includes a broad sample. Forty subjects, aged 8-56 years (mean=22), all with mental retardation and 36 with autism spectrum disorders participated in this 22-week crossover study, with 24 weeks of open maintenance thereafter. Of 40 subjects, 23 (57.5%) responded fully (50% decrease in Aberrant Behavior Checklist-Community Irritability subscale score), while 35 subjects (87.5%) showed a 25% decrease. Gender, mood disorder, and antiseizure medications did not alter response. Increased appetite and weight gain were common. Low dose risperidone was effective for aggressive behavior in persons with MR. More long-term studies are needed, incorporating weight control interventions.
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Affiliation(s)
- Jessica A Hellings
- Department of Psychiatry, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, USA.
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Hellings JA, Zarcone JR, Valdovinos MG, Reese RM, Gaughan E, Schroeder SR. Risperidone-induced prolactin elevation in a prospective study of children, adolescents, and adults with mental retardation and pervasive developmental disorders. J Child Adolesc Psychopharmacol 2005; 15:885-92. [PMID: 16379508 DOI: 10.1089/cap.2005.15.885] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Risperidone is widely prescribed for aggression and self-injury in children, adolescents, and adults with mental retardation (MR) and pervasive developmental disorders (PDD). Risperidone elevates prolactin more than other atypical antipsychotic medications. Females may show greater prolactin elevation than males. METHOD In this relatively long-term study of risperidone efficacy and safety for aggression and self-injury in children, adolescents, and adults with MR and PDDs, serum prolactin was measured in a 21-subject subset during the course of a double-blind, placebo-controlled trial. Prolactin was measured in ng/mL at baseline, once during acute treatment, and once during maintenance. RESULTS In children and adolescents (n=10), mean age of 12.5 years, prolactin increased from mean 13.2+/-8.6 at baseline to 31.0+/-11.6 acutely and remained elevated at 37.9+/-10.4 in maintenance. In adults, mean age of 35.3 years, prolactin increased more markedly from 11.6+/-7.4 baseline (n=11) to 93.3+/-54.2 acutely but decreased to 67.8+/-62.9 in maintenance (n=7). Prolactin remained significantly elevated above normal in all subjects for at least 26 weeks. Mean prolactin of adult females, while similar to that of adult males at baseline, was 2.2 times male levels acutely and 3.7 times greater in maintenance. CONCLUSION In this small subset, mean prolactin elevation persisted for at least 26 weeks. In adults, females showed significantly greater elevations than males.
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Affiliation(s)
- Jessica A Hellings
- University of Kansas Medical Center, Department of Psychiatry and Behavioral Sciences, Kansas City, Kansas 66160, USA.
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Abstract
People with mental retardation, autism, and related developmental disabilities who self-injure are treated with a wide array of behavioral techniques and psychotropic medications. Despite numerous reports documenting short-term and some long-term changes in self-injury associated with the opiate antagonist naltrexone hydrochloride, no quantitative review of its efficacy has been reported. We conducted a quantitative synthesis of the peer-reviewed published literature from 1983 to 2003 documenting the use of naltrexone for the treatment of self-injurious behavior (SIB). Individual-level results were analyzed given subject and study characteristics. A sample of 27 research articles involving 86 subjects with self-injury was reviewed. Eighty percent of subjects were reported to improve relative to baseline (i.e., SIB reduced) during naltrexone administration and 47% of subjects SIB was reduced by 50% or greater. In studies reporting dose levels in milligrams, males were more likely than females to respond. No significant relations were found between treatment outcomes and autism status or form of self-injury. Results are discussed with respect to future efficacy work related to study outcomes and the pharmacological treatment of self-injury.
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Affiliation(s)
- Frank J Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Abstract
This paper identifies instruments and measures that may be appropriate for randomized clinical trials in participants with autism spectrum disorders (ASDs). The Clinical Global Impressions scale was recommended for all randomized clinical trials. At this point, however, there is no "perfect" choice of outcome measure for core features of autism, although we will discuss five measures of potential utility. Several communication instruments are recommended, based in part on suitability across the age range. In trials where the intention is to alter core features of ASDs, adaptive behavior scales are also worthy of consideration. Several "behavior complexes" common to ASDs are identified, and instruments are recommended for assessment of these. Given the prevalence of cognitive impairment in ASDs, it is important to assess any cognitive effects, although cognitive data from ASD randomized clinical trials, thus far, are minimal. Guidance from trials in related pharmacologic areas and behavioral pharmacology may be helpful. We recommend routine elicitation of side effects, height and weight, vital signs, and (in the case of antipsychotics) extrapyramidal side-effects assessment. It is often appropriate to include laboratory tests and assessments for continence and sleep pattern.
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Affiliation(s)
- Michael G Aman
- Department of Psychology, Nisonger Center, Ohio State University, Columbus 43210-1257, USA.
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Valdovinos MG, Schroeder SR, Kim G. Prevalence and Correlates of Psychotropic Medication Use among Adults with Developmental Disabilities: 1970–2000. Elsevier; 2003. pp. 175-220. [DOI: 10.1016/s0074-7750(03)01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Hammock R, Levine WR, Schroeder SR. Brief report: effects of clozapine on self-injurious behavior of two risperidone nonresponders with mental retardation. J Autism Dev Disord 2001; 31:109-13. [PMID: 11439749 DOI: 10.1023/a:1005626100084] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Atypical antipsychotic medications for self-injurious behavior (SIB), aggression, and destruction among people with mental retardation and development disabilities are becoming increasingly accepted. Most studies are on risperidone and fewer have been conducted on clozapine. The present single-blind study reports marked reductions in SIB and aggression of two persons with profound mental retardation who were nonresponsive to all other behavioral and psychopharmacological interventions, including risperidone. The most effective dose was 200 mg/day. Side effects were mild and the drug was tolerated well.
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Affiliation(s)
- R Hammock
- University of Kansas, Lawrence, Kansas 66045, USA
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