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New Class of Antipsychotic Drug Helps Severe Autism

Risperidone eases form of disease marked by tantrums, self-harm

WEDNESDAY, July 31, 2002 (HealthDayNews) -- Newer antipsychotic drugs are safe and effective for the treatment of autism marked by severe behavior problems like tantrum throwing, aggression and self-inflicted injuries.

That's the conclusion of a new study, which found that one member of that drug family, risperidone, led to marked improvements in unwanted behaviors with few serious side effects.

Even so, the researchers said, the treatment didn't lead to changes in the "core" symptoms of autism, and therefore should be reserved for patients with more severe illness. A report on the findings appears in tomorrow's issue of the New England Journal of Medicine.

Autism is a mysterious emotional and behavior disorder that affects 20 out of every 10,000 children in this country, according to the National Institute of Mental Health. It has a strong genetic component and may result from abnormal brain chemistry, but researchers aren't yet sure what causes the condition. What doesn't, however, is bad parenting and early childhood vaccinations, both of which were once blamed for autism but have since been absolved.

Most children with autism have mild forms of the disorder. They may start talking later than normal or have trouble relating to their peers socially. But about 10 percent or so have much more serious difficulties. They lash out physically against themselves and others, throw violent temper tantrums, and are extremely unpredictable and hard to control.

Risperidone is sold as Risperdal by Janssen Pharmaceutica Products, a division of Johnson & Johnson. It belongs to a class of medications called atypical antipsychotics, which are used to treat conditions like schizophrenia.

These drugs are often used to treat autism with serious behavior problems, too, as are behavior therapy and, occasionally, stimulants such as Ritalin when the disorder is accompanied by hyperactivity and attention troubles. But researchers hitherto have had little evidence of their safety in children, said Dr. Elaine Tierney, a psychiatrist at Johns Hopkins University School of Medicine in Baltimore and a co-author of the study.

Tierney and her colleagues compared the use of Risperdal therapy and sugar pills in 82 boys and 19 girls, who ranged in age from 5 to 17.

After eight weeks, children taking the drug had an almost 60 percent drop on a standard measure of irritability, compared with just a 14 percent decline in the untreated group. Almost 70 percent of the treated children had at least a 25 percent decrease in their irritability scores and either were much or very much improved on another scale. That figure was 12 percent in the placebo group.

The researchers also noted that the drug led to improvements in hyperactivity and repetitive behaviors like movement and speech patterns.

Of the children who responded to the drug, two-thirds continued to see benefit after six months of treatment.

Side effects from the drug were typically mild, the researchers found, and included drowsiness, dizziness and drooling. The biggest problem appeared to be an increase in appetite, which led to significant weight gain in some children. The average gain was a little more than six pounds, but some put on much more.

That effect was not surprising, Tierney said, since it's common in adults who take the drug and its kin. But older patients are better able to control their eating, she said, so they tend not to add as many pounds.

Tierney said that while the results of the study aren't new to autism experts, many children don't have access to these specialists, especially those versed in behavioral therapy. Instead, they may be treated by primary care or family physicians who aren't familiar with the benefits of the new antipsychotic drugs.

"It's helpful for these individuals to have medication, and here are the side effects," she said.

What To Do

Learn about autism from the National Institute of Mental Health, which helped fund the latest study. You can also find out more by visiting the Autism Society of America.

SOURCES: Elaine Tierney, M.D., director of psychiatry, Kennedy Krieger Institute, and assistant professor of psychiatry, Johns Hopkins University School of Medicine, Baltimore; Aug. 1, 2002, New England Journal of Medicine
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