Psychopharmacology in children with PDD: Review of current evidence

Abstract

Over the past 20 years, there has been an increase in the identification of children with autism and phenotypically related conditions, Asperger disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) (Fombonne 2005). This increased recognition has brought in its wake greater demand for interventions - educational, psychosocial and psychopharmacological. A look at the literature over the past 20 years shows a rather impressive list of medications that have been examined in children with pervasive developmental disorders (PDDs) - albeit with varying degrees of rigor. These include antipsychotics, such as haloperidol and risperidone, alpha-2 agonists, such as clonidine and guanfacine, methylphenidate, antidepressants and the gastrointestinal hormone, secretin. In addition, medication such as fenfluramine, amantadine, and naltrexone has been examined in at least one study. To date, the best-studied medication in children with PDD is secretin, which has been examined in approximately 13 placebo-controlled trials (Levy and Hyman 2005). It has yet to show superiority to placebo. Although several medications have been evaluated for treatment of children with PDD, only a handful of trials have included more than 40 subjects. Over the past decade, however, evidence has emerged on the use of risperidone, the selective serotonin reuptake inhibitors (SSRIs), fluoxetine and citalopram, and methylphenidate in children with PDDs. Coincidently, these three classes of medication are also among the most commonly used in this population (Aman et al. 2003; Oswald and Sonenklar 2007; Mandell et al. 2008). This chapter reviews results from recently published reports mostly from federally-funded, multi-site randomized clinical trials. The review is organized according to target symptoms for medication intervention in children with PDDs, such as hyperactivity and impulsiveness, repetitive behavior, and the triad seriously maladaptive behavior: tantrums, aggression, and self-injury. © 2011 Springer Science+Business Media, LLC.