Sunday, November 29, 2009

Kids with autism do better when parents receive specialized training

From The New Haven Register in Conn.:

NEW HAVEN, Conn. — Giving parents of autistic children specialized training helps children with severe behavior problems better than medication alone, according to a Yale professor.

“The conclusion is that for children with pervasive developmental disorders ... (they) will benefit from medication and parent training,” said Lawrence Scahill, professor at Yale School of Nursing and the Yale Child Study Center, a principal investigator.

The 24-week trial was conducted at Yale, Ohio State and Indiana universities. The results were published in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Scahill said the focus of the study was children on the autism spectrum, age 4 to 13, who have “serious behavioral problems,” including “daily and prolonged tantrums, aggression and self-injury.”

“These behaviors may occur in response to normal expectations of everyday living, such as getting dressed, getting ready for bed or making transitions between one activity and another,” Scahill said.

Two groups of children on the autism spectrum were given the anti-psychotic medication risperidone (Risperdal).

The parents of the children in one group also were given the one-to-one training, including two home visits.

“Both groups improved, but over six months, the group that received parent training showed greater and more stable benefit,” Scahill said.

He said the training “entails 14 sessions, primarily involving the parent, in which the parent is taught to think differently about the child’s misbehavior and then to respond differently.”

Parents will sometimes reinforce negative behavior, Scahill said. For example, they may react to a tantrum over a child dressing himself by dressing him themselves.

Techniques include breaking the task into small parts to achieve success and avoiding the opportunity for conflicts when possible.

“The mother takes the child to Stop & Shop and then takes the child to another store and another store — by the third stop, the kid has had it,” he said.

The study was conducted by the National Institute of Mental Health Research Units on Pediatric Psychopharmacology. Results from a 2002 RUPP report showed most children’s symptoms returned when the medication was discontinued after six months.

Risperidone can bring on weight gain, which can lead to obesity and related health problems.

Further study will be needed to see how long the added benefit of the training lasts, Scahill said. “Our data go out six months ... It’s actually the last month or so that you start to see separation of the two graphs.”

Scahill said future research may involve preschool-age children to see if early intervention will make medication unnecessary.