Research Review

Parent Training Complements Medication for Behavioral Problems in Children With PDD

Treatment that includes medication plus a structured training program for parents reduces serious behavioral problems in children with autism and related conditions, according to a study funded by the National Institute of Mental Health (NIMH) and published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Results from a previous study reported in 2002 showed that the antipsychotic medication risperidone (Risperdal) reduced such behavior problems as tantrums, aggression, and self-injury in children with autism. However, most children's symptoms returned when the medication was discontinued. Although effective, risperidone is associated with adverse effects such as weight gain, which can lead to metabolic changes, obesity, and related health problems.

In the study, researchers tested the benefits of medication alone compared with medication plus a parent training program that actively involves parents in managing their children's severely disruptive and noncompliant behavior. Parents were taught to modify their children's behavior and learned to enhance their children's daily living skills.

The 24-week, three-site trial included 124 children aged 4 to 13 with pervasive developmental disorders (PDD) such as autism, Asperger's, or related disorders accompanied by tantrums, aggression, and self-injury. The children were randomized to a combination of risperidone and parent training, or to risperidone only. Parents in combination therapy received an average of 11 sessions of training over the course of the study.

Although both groups improved over the six-month trial, the group receiving combination therapy showed greater reduction in behavioral problems like irritability, tantrums, and impulsiveness compared with the group receiving medication only. The combination therapy group also ended the trial taking an average dose of 1.98 milligrams (mg) per day of risperidone, compared to 2.26 mg/day in the medication-only group—a 14% lower dose. However, children in both groups gained weight, indicating "a need to learn more about the metabolic consequences of medications like risperidone," wrote the authors.

"Future studies will evaluate whether the benefits of parent training endure over a long period of time," concluded the authors. The investigators also plan to apply the parent training to younger children with PDD to prevent the evolution of serious behavioral problems. Future studies may also look for ways in which the parent training program can be used in schools and community clinics.

— Source: National Institutes of Health