Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial
Aman, M.G., McDougle, C.L., Scahill, L., Handen, B., Arnold, L.E., Johnson, C., Stigler, K.A., Bearss, K., Butter, E., Swiezy, N.B., Sukhodolsky, D.D., Ramadan, Y., Pozdol, S.L., Nikolov, R., Lecavalier, L., Kohn, A.E., Koenig, K., Hollway, J.A., Hall, K.L., Dzuir, J., Ritz, L., Trollinger, S., Yu, S., Vitiello, B., & Wagner, A. (2009). Medication and Parent Training in Children with Pervasive Developmental Disorders and Serious Behavior Problems: Results from a Randomized Clinical Trial. Journal of the Academy of Child and Adolescent Psychiatry, 48 (12), 1143-1154.
Reviewed by Amy Hansford, MA
Why study this topic?
The Food and Drug Administration has approved the drug risperidone (Risperdal) for the treatment of aggression and irritability associated with autism. There is also evidence that applied behavior analytic (ABA) interventions can be helpful in treating these problems. This study is the first large-scale investigation of whether a combination of Risperdal and ABA intervention is more efficacious than Risperdal alone.
What did the researchers do?
The researchers evaluated the effectiveness of combining medication treatment (using Risperidone) with parent training that focused on teaching parents to use ABA principles for improving adaptive skills and reducing problem behavior (e.g., frequent tantrums, self-injury, and aggression). Parent training included at least 11 sessions with a trained clinician; sessions focused on teaching and applying principles, role-playing, and homework for the parent to implement ABA procedures with the child with autism. One hundred and twenty-four children between the ages of four and 13 were enrolled in this study across three sites. Participants were randomly assigned to one of two groups for the 24-week trial: with one group receiving both daily doses of Risperidone and a parent training intervention (75 participants), and one receiving medication only (49 participants).
Children were assessed for several outcomes, including changes in maladaptive behavior and irritability, and adaptive skills using parent questionnaires and clinician ratings.
What did the researchers find?
The researchers found that participants in the combined group (medication with parent training) showed significantly greater improvements than those in the medication only group at the end of the trial. These improvements were seen within measures of maladaptive behavior, aggression and irritability, as well as stereotyped behaviors. The researchers also found that at the end of the 24-week trial, participants in the medication only group were on higher doses than those in the combined group.
What were the strengths and limitations of the study? What do the results mean?
Overall, researchers concluded that a combined treatment with medication and parent training yielded greater behavioral improvements than medication alone and that the improvements in the combined group were achieved using lower medication dosages, which may reduce the possibility of harmful side effects.
While showing improvements in reducing problem behaviors, the researchers did note that the greater contact with therapists experienced by the combined group may account for some of the improvements seen in this study. This then highlights the need to further evaluate the parent training component of this study for its effectiveness.