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Study: New Drug May Aid Autistic
Children
Schizophrenia Medicine Found to Control Outbursts
Associated With Disorder
By Shankar Vedantam,
Washington Post, August 1, 2002
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.
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