Study: New Drug May Aid Autistic Children
Schizophrenia Medicine Found to Control
Outbursts Associated With Disorder
By Shankar Vedantam
Parents and educators can control the tantrums, aggression and
self-injurious behavior of children with autism and related disorders by
placing them on an antipsychotic medicine that is approved only to treat
schizophrenia in adults, researchers reported yesterday.
Many psychiatrists have already placed children with autism and related
problems on Risperdal, a member of a new class of schizophrenia medicines.
Although the Food and Drug Administration has not approved such "off-label"
use, doctors expect the new report to greatly expand antipsychotic
prescriptions for this purpose.
Some mental health experts have expressed concern about the use of
powerful medicines among young children. Worried by a spiraling rise in
prescriptions, the New York State Office of Mental Health recently asked a
panel of experts to study the long-term risks.
Some children with autism, an incurable disorder that can impair
language, cognition and social skills, are easily provoked to uncontrolled
bursts of anger and frustration, making it difficult for them to benefit
from the intense learning structure that is the only way such children can
acquire knowledge and routine social skills.
These outbursts range from tantrums, during which autistic children might
slam doors or tip over tables, to outright violence, in which they might
throw things at people, bite or scratch themselves or others, or bang their
head with their fists, said Lawrence Scahill, an associate professor in
child psychiatry and nursing at Yale University.
"If the medicine could reduce these behaviors, the child may be more
available to remedial and rehabilitative efforts to learn, to dress
themselves, to get on the school bus and make it to school," said Scahill,
the principal investigator in a study published today in the New England
Journal of Medicine.
Although a few small studies conducted by pharmaceutical companies had
indicated similar results, the new report is the first comprehensive
evaluation. It was paid for by the federal government's National Institute
of Mental Health.
Scahill and a team of researchers at several universities studied the use
of Risperdal in a trial of 101 children ages 5 to 17. The autistic children
received either the medicine or a dud pill for eight weeks, and were then
tracked for six months.
"At relatively low doses, the medicine was effective in reducing serious
behavioral problems in children with autism," Scahill said. "It did not make
a big impact on the core symptoms [of autism] but had a big effect on
aggression, self-injury and tantrums."
It is unclear exactly how many children may be candidates for the
treatment, because estimates of autism numbers vary. The federal government
estimates that 75,000 to 150,000 children nationwide have autism.
"An autistic child can endanger his siblings," said Eric London, the
founder of the National Alliance for Autism Research, an advocacy group in
Princeton, N.J. "If you have a small baby in the home, it's intolerable to
have an autistic child rampaging through the house. For those families,
Risperdal could be a godsend."
About 40 percent to 50 percent of autistic children may already be on
psychotropic medicines, London said.
Sharon Carpinello, executive deputy commissioner of the New York State
Office of Mental Health, whose panel on the trend was first reported July 23
in USA Today, said in an interview yesterday: "Our concern in the increase
in the use of antipsychotic drugs for children is that most of the trials
that have been done are on the adult side. . . . We know very little about
the long-term effects in children."
Diabetes, obesity and sedation were among the concerns generally
associated with the class of drugs -- children in the trial on Risperdal had
significant weight gain. "How does that translate into children as they move
through adolescence?" Carpinello asked.
But Joseph Coyle, a Harvard University psychiatrist, said, "The advantage
of Risperdal over the classical antipsychotics is a much reduced risk of
both acute neurologic side effects and delayed side effects."
The researchers agreed that autistic children should be placed on the
medicine only as a last resort, only at low doses and only long enough to
become stabilized.
© 2002 The Washington Post Company
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