Risk factors of acute behavioral regression in psychiatrically hospitalized adolescents with autism.
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.
Périsse
Didier
D
Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Paris, France.
Amiet
Claire
C
Consoli
Angèle
A
Thorel
Marie-Vincente
MV
Gourfinkel-An
Isabelle
I
Bodeau
Nicolas
N
Guinchat
Vincent
V
Barthélémy
Catherine
C
Cohen
David
D
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