Trial design challenges when combining medication and parent training in children with pervasive developmental disorders.
This paper presents the rationale for a 24-week, randomized trial designed to test whether risperidone plus structured parent training would be superior to risperidone only on measures of noncompliance, irritability and adaptive functioning. In this model, medication reduces tantrums, aggression and self-injury; parent training promotes improvement in noncompliance and adaptive functioning. Thus, medication and parent training target related, but separate, outcomes. At week 24, the medication was gradually withdrawn to determine whether subjects in the combined treatment group could be managed on a lower dose or off medication without relapse. Both symptom reduction and functional improvement are important clinical treatment targets. Thus, experimental evidence on the beneficial effects of combining pharmacotherapy and exportable behavioral interventions is needed to guide clinical practice.
Scahill
Lawrence
L
Child Study Center, Yale University, New Haven, CT 06520, USA. Lawrence.scahill@yale.edu
Aman
Michael G
MG
McDougle
Christopher J
CJ
Arnold
L Eugene
LE
McCracken
James T
JT
Handen
Benjamin
B
Johnson
Cynthia
C
Dziura
James
J
Butter
Eric
E
Sukhodolsky
Denis
D
Swiezy
Naomi
N
Mulick
James
J
Stigler
Kimberly
K
Bearss
Karen
K
Ritz
Louise
L
Wagner
Ann
A
Vitiello
Benedetto
B
D000293:Adolescent; D000374:Aggression / Q000187:drug effects / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales; D018967:Risperidone / Q000627:therapeutic use*; D016728:Self-Injurious Behavior / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
D018492:Dopamine Antagonists; D018967:Risperidone