title: Risk factors of acute behavioral regression in psychiatrically hospitalized adolescents with autism.
abstract: OBJECTIVE
  During adolescence, some individuals with autism engage in severe disruptive behaviors, such as violence, agitation, tantrums, or self-injurious behaviors. We aimed to assess risk factors associated with very acute states and regression in adolescents with autism in an inpatient population.
  
  
  METHODS
  Between 2001 and 2005, we reviewed the charts of all adolescents with autism (N=29, mean age=14.8 years, 79% male) hospitalized for severe disruptive behaviors in a psychiatric intensive care unit. We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), associated organic conditions, etiologic diagnosis of the episode, and treatments.
  
  
  RESULTS
  All patients exhibited severe autistic symptoms and intellectual disability, and two-thirds had no functional verbal language. Fifteen subjects exhibited epilepsy, including three cases in which epilepsy was unknown before the acute episode. For six (21%) of the subjects, uncontrolled seizures were considered the main cause of the disruptive behaviors. Other suspected risk factors associated with disruptive behavior disorders included adjustment disorder (N=7), lack of adequate therapeutic or educational management (N=6), depression (N=2), catatonia (N=2), and painful comorbid organic conditions (N=3).
  
  
  CONCLUSIONS
  Disruptive behaviors among adolescents with autism may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic diseases such as epilepsy. The management of these behavioral changes requires a multidisciplinary functional approach.
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Périsse
authors.forename: Claire
authors.initials: C
authors.lastname: Amiet
authors.forename: Angèle
authors.initials: A
authors.lastname: Consoli
authors.forename: Marie-Vincente
authors.initials: MV
authors.lastname: Thorel
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gourfinkel-An
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bodeau
authors.forename: Vincent
authors.initials: V
authors.lastname: Guinchat
authors.forename: Catherine
authors.initials: C
authors.lastname: Barthélémy
authors.forename: David
authors.initials: D
authors.lastname: Cohen
references.citation: Am J Psychiatry. 1994 Jul;151(7):1043-7
references.pmid: 8010362
references.citation: J Autism Dev Disord. 1992 Sep;22(3):395-411
references.pmid: 1383189
references.citation: J Neurol Neurosurg Psychiatry. 1998 Oct;65(4):555-60
references.pmid: 9771784
references.citation: Pediatr Neurol. 1999 Jul;21(1):464-70
references.pmid: 10428432
references.citation: Res Dev Disabil. 2008 Mar-Apr;29(2):141-8
references.pmid: 17350800
references.citation: Epilepsia. 2007 Sep;48(9):1724-1730
references.pmid: 17555525
references.citation: Br J Psychiatry. 1967 Nov;113(504):1169-82
references.pmid: 6075451
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2008 Aug 1;32(6):1393-8
references.pmid: 18417262
references.citation: N Engl J Med. 1997 Jul 10;337(2):97-104
references.pmid: 9211680
references.citation: Eur Psychiatry. 2002 Jul;17(4):206-12
references.pmid: 12231266
references.citation: J Autism Dev Disord. 2003 Aug;33(4):365-82
references.pmid: 12959416
references.citation: J Autism Dev Disord. 2002 Aug;32(4):299-306
references.pmid: 12199134
references.citation: J Child Psychol Psychiatry. 2004 Feb;45(2):212-29
references.pmid: 14982237
references.citation: J Autism Dev Disord. 2003 Dec;33(6):565-81
references.pmid: 14714927
references.citation: Psychiatry Clin Neurosci. 1998 Aug;52(4):383-90
references.pmid: 9766685
references.citation: J Autism Dev Disord. 2007 Oct;37(9):1735-47
references.pmid: 17146700
references.citation: Am J Med Genet A. 2005 Jun 1;135(2):171-80
references.pmid: 15887228
references.citation: Br J Psychiatry. 2006 Oct;189:361-6
references.pmid: 17012660
references.citation: Psychol Rep. 1995 Aug;77(1):207-10
references.pmid: 7501761
references.citation: Lancet Neurol. 2002 Oct;1(6):352-8
references.pmid: 12849396
references.citation: Schizophr Res. 2005 Jul 15;76(2-3):301-8
references.pmid: 15949662
references.citation: Pediatr Neurol. 1997 Feb;16(2):137-40
references.pmid: 9090688
references.citation: J Autism Dev Disord. 1981 Dec;11(4):365-71
references.pmid: 7052813
references.citation: J Autism Dev Disord. 2005 Feb;35(1):103-16
references.pmid: 15796126
references.citation: J Autism Dev Disord. 1980 Mar;10(1):91-103
references.pmid: 6927682
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Nov;36(11):1561-9
references.pmid: 9394941
references.citation: J Psychiatr Pract. 2008 Jan;14(1):5-12
references.pmid: 18212598
references.citation: Int Rev Neurobiol. 2006;72:41-54
references.pmid: 16697290
references.citation: J Can Acad Child Adolesc Psychiatry. 2006 Aug;15(3):135-42
references.pmid: 18392183
references.citation: Pediatr Neurol. 1996 Oct;15(3):217-23
references.pmid: 8916159
references.citation: Br J Psychiatry. 1967 Nov;113(504):1183-99
references.pmid: 6075452
references.citation: J Autism Dev Disord. 2005 Jun;35(3):351-60
references.pmid: 16119476
references.citation: Br J Psychiatry. 2000 Apr;176:357-62
references.pmid: 10827884
references.citation: J Autism Dev Disord. 1987 Jun;17(2):273-87
references.pmid: 3610999
references.citation: Acta Psychiatr Scand. 1998 Feb;97(2):99-108
references.pmid: 9517902
references.citation: Schizophr Res. 2009 Sep;113(2-3):233-40
references.pmid: 19443182
references.citation: Eur Child Adolesc Psychiatry. 2009 Mar;18(3):185-93
references.pmid: 19129964
references.citation: Biol Psychiatry. 2008 Oct 1;64(7):577-82
references.pmid: 18565495
references.citation: Res Dev Disabil. 2009 May-Jun;30(3):572-86
references.pmid: 18845418
references.citation: J Child Psychol Psychiatry. 1992 Mar;33(3):489-507
references.pmid: 1577895