Parent training, medication help curb dangerous behavior

Early parent training on how to best teach and communicate with their child – when combined with medication – may be the key to reducing the destructive behavior that often afflicts children with autism spectrum disorders, according to a multi-site study coordinated by a Yale University professor. Even more promising is the treatment combination’s potential as more cost- and time-effective alternative to applied behavior analysis (ABA) or similar psychological treatments.

The study was published in the Dec. 2009 issue of Journal of the American Academy of Child and Adolescent Psychiatry, and chronicled the work of Larry Scahill Ph.D., and his fellow researchers who concurrently executed the study at Ohio State and Indiana Universities. The results showed that the 124 randomly selected participants age four through 13 reduced their tantrums, aggressive and self-injurious behavior and increased their daily adaptive behavior … but their treatment had to comprise both risperidone and practiced adapted parenting methods their care givers learned during a six-month, 14-session program.

“Our goal was to test if the addition of parent training would [reduce] target behavior or improve adaptive behavior as well,” says Scahill, a jointly appointed professor at the Yale School of Nursing and the Medical Center, and director of the Research Unit on Pediatric Psychopharmacology (RUPP) at the Yale Child Study Center. “We actually predicted there would be clear benefits in daily living skills for children with pervasive developmental disorders suffering from tantrums and self-injurious behavior.”

In 1998, Scahill answered a government call for grants to study psychopharmacology in children with autism spectrum disorders and severe behavior problems. Those who submitted grants eventually formed RUPP. Five years into its work, the group decided to focus on the effects of combined medical treatment with behavioral treatment. Over time, the research led to the current study.

In earlier studies, says Scahill, risperidone was “very effective in reducing self injury” and results were stable for six months; but if you took the drug away, the behavior came back. “This led us down the trail of being interested in seeing if there would be an additional benefit to behavioral intervention and if there would be an increase in positive behavior,” he says.

Scahill and his colleagues believed that the medication would reduce the bad behavior … but would the introduction of parent training create enough room for life skills to increase? “Giving a mother our best methods for complying with the demands of everyday life, we’d see if it would transition to children making gains in everyday life.”

Parent training was based on a manual created by Scahill and his colleagues and was administered on a one-clinician-to-one-parent/couple basis. Each session lasted 60-90 minutes and comprised learning tools on things like toilet training, sleep schedules and time-outs through videos, practice activities and role-playing. Results of decreased bad behavior were measured using the Aberrant Behavior Checklist, the standard Clinical Global Impressions Scale, the Home Situations Questionnaire and Vineland  Adaptive Behavior Scales.

Risperidone alone reduced bad behavior by 50 percent; combined with parent training, behavior dropped an additional 15-20 percent. In some cases, the risperidone doses were also decreased because of improved behavior.

“What we are charged up about is that we’ve already shown that it can be done in more than one center,” says Scahill. “That means this is potentially an expandable intervention that can be taken up by knowledgeable clinicians. What’s more, the traditional use of applied behavior analysis in children with autism, although effective, is a lengthy, costly treatment. The current study hints at the promise of a treatment that could be more widely accessible to the masses.

According to the report published in the journal, the study is believed to be the first of its kind to examine the benefits of parent training and medication. This was the first report based on the study; Scahill predicts up to 10 more may follow.