TY - JOUR
T1 - Effects of risperidone and parent training on adaptive functioning in Children with Pervasive Developmental Disorders and serious behavioral problems
AU - Scahill, Lawrence
AU - McDougle, Christopher J.
AU - Aman, Michael G.
AU - Johnson, Cynthia
AU - Handen, Benjamin
AU - Bearss, Karen
AU - Dziura, James
AU - Butter, Eric
AU - Swiezy, Naomi G.
AU - Arnold, L. Eugene
AU - Stigler, Kimberly A.
AU - Sukhodolsky, Denis D.
AU - Lecavalier, Luc
AU - Pozdol, Stacie L.
AU - Nikolov, Roumen
AU - Hollway, Jill A.
AU - Korzekwa, Patricia
AU - Gavaletz, Allison
AU - Kohn, Arlene E.
AU - Koenig, Kathleen
AU - Grinnon, Stacie
AU - Mulick, James A.
AU - Yu, Sunkyung
AU - Vitiello, Benedetto
PY - 2012/2
Y1 - 2012/2
N2 - Objective: Children with Pervasive Developmental Disorders (PDDs) have social interaction deficits, delayed communication, and repetitive behaviors as well as impairments in adaptive functioning. Many children actually show a decline in adaptive skills compared with age mates over time. Method: This 24-week, three-site, controlled clinical trial randomized 124 children (4 through 13 years of age) with PDDs and serious behavioral problems to medication alone (MED; n = 49; risperidone 0.5 to 3.5 mg/day; if ineffective, switch to aripiprazole was permitted) or a combination of medication plus parent training (PT) (COMB; n = 75). Parents of children in COMB received an average of 11.4 PT sessions. Standard scores and Age-Equivalent scores on Vineland Adaptive Behavior Scales were the outcome measures of primary interest. Results: Seventeen subjects did not have a post-randomization Vineland assessment. Thus, we used a mixed model with outcome conditioned on the baseline Vineland scores. Both groups showed improvement over the 24-week trial on all Vineland domains. Compared with MED, Vineland Socialization and Adaptive Composite Standard scores showed greater improvement in the COMB group (p =.01 and.05, and effect sizes = 0.35 and 0.22, respectively). On Age Equivalent scores, Socialization and Communication domains showed greater improvement in COMB versus MED (p =.03 and 0.05, and effect sizes = 0.33 and 0.14, respectively). Using logistic regression, children in the COMB group were twice as likely to make at least 6 months' gain (equal to the passage of time) in the Vineland Communication Age Equivalent score compared with MED (p =.02). After controlling for IQ, this difference was no longer significant. Conclusion: Reduction of serious maladaptive behavior promotes improvement in adaptive behavior. Medication plus PT shows modest additional benefit over medication alone. Clinical trial registration informationRUPP PI PDD: Drug and Behavioral Therapy for Children With Pervasive Developmental Disorders; http://www.clinicaltrials.gov; NCT00080145.
AB - Objective: Children with Pervasive Developmental Disorders (PDDs) have social interaction deficits, delayed communication, and repetitive behaviors as well as impairments in adaptive functioning. Many children actually show a decline in adaptive skills compared with age mates over time. Method: This 24-week, three-site, controlled clinical trial randomized 124 children (4 through 13 years of age) with PDDs and serious behavioral problems to medication alone (MED; n = 49; risperidone 0.5 to 3.5 mg/day; if ineffective, switch to aripiprazole was permitted) or a combination of medication plus parent training (PT) (COMB; n = 75). Parents of children in COMB received an average of 11.4 PT sessions. Standard scores and Age-Equivalent scores on Vineland Adaptive Behavior Scales were the outcome measures of primary interest. Results: Seventeen subjects did not have a post-randomization Vineland assessment. Thus, we used a mixed model with outcome conditioned on the baseline Vineland scores. Both groups showed improvement over the 24-week trial on all Vineland domains. Compared with MED, Vineland Socialization and Adaptive Composite Standard scores showed greater improvement in the COMB group (p =.01 and.05, and effect sizes = 0.35 and 0.22, respectively). On Age Equivalent scores, Socialization and Communication domains showed greater improvement in COMB versus MED (p =.03 and 0.05, and effect sizes = 0.33 and 0.14, respectively). Using logistic regression, children in the COMB group were twice as likely to make at least 6 months' gain (equal to the passage of time) in the Vineland Communication Age Equivalent score compared with MED (p =.02). After controlling for IQ, this difference was no longer significant. Conclusion: Reduction of serious maladaptive behavior promotes improvement in adaptive behavior. Medication plus PT shows modest additional benefit over medication alone. Clinical trial registration informationRUPP PI PDD: Drug and Behavioral Therapy for Children With Pervasive Developmental Disorders; http://www.clinicaltrials.gov; NCT00080145.
KW - adaptive behavior
KW - children
KW - parent training
KW - pervasive developmental disorders
KW - risperidone
UR - http://www.scopus.com/inward/record.url?scp=84855984767&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84855984767&partnerID=8YFLogxK
U2 - 10.1016/j.jaac.2011.11.010
DO - 10.1016/j.jaac.2011.11.010
M3 - Article
C2 - 22265360
AN - SCOPUS:84855984767
SN - 0890-8567
VL - 51
SP - 136
EP - 146
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 2
ER -