Pervasive Developmental Disorder Medication

  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Jun 7, 2011
 

Medication Summary

Many types of medications are used to address different behavioral issues and comorbid disorders associated with pervasive developmental disorder (PDD). For example, the US Food and Drug Administration (FDA) has approved risperidone and aripiprazole for use in children to treat irritability associated with autistic disorder.[29, 30]

Data from several large, randomized, placebo-controlled trials suggested that antipsychotic medications may be helpful, particularly for aggression. In addition, treatment with antipsychotics may improve restricted, repetitive, and stereotyped patterns of behavior and interests. However, no medications substantially change deficits in social interaction and communication.

The use of antipsychotic medications requires careful monitoring of weight, fasting lipid profile, and fasting plasma glucose as recommended by the consensus statement published in Diabetes Care.[31]

Treatment of comorbid conditions such as ADHD and OCD may be indicated, although few research studies support the efficacy of the medications currently approved for use in children who are developing normally. Because FDA guidance is absent, child and adolescent psychiatrists target disruptive behaviors with the class of medications indicated by the symptom clusters.[32]

Innovative treatments currently in the development phase include N-methyl-D-aspartate (NMDA) receptor (a type of glutamate receptor) blockers. A preliminary trial using a similar agent, amantadine, proved promising in a placebo-controlled trial.[33] Inhibition of group 1 metabotropic glutamate receptor is being considered specifically in the use of individuals with fragile X syndrome, because studies demonstrate that FMRP affects dendrite maturation via this neurotransmitter system.[34]

Herbal and alternative treatments require more research. The most promising is melatonin, the hormone that regulates sleep. A pharmaceutical-grade, melatonin like compound, ramelteon, is available commercially. Children with PDD often have sleep disorder that may be ameliorated with melatonin.[35]

Other herbal treatments should be carefully weighed like any traditional medication for their risks and benefits. Most importantly, parents should be cautioned that little oversight exists for these compounds and that some have been found to contain unacceptable levels of heavy metals.[36] Intravenous chelation has been identified by the American Academy of Pediatrics as particularly risky without demonstrated benefit, resulting in 1 reported death.[37]

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Antipsychotics

Class Summary

Antipsychoticmedications may help with a patient’s aggressive behavior and may improve restricted, repetitive, and stereotyped patterns of behavior and interests.

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Risperidone (Risperdal)

 

Risperidone is an atypical antipsychotic agent. It binds to the dopamine D2-receptor with 20 times lower affinity than for 5-HT2-receptor affinity. It improves negative symptoms of psychoses and reduces the incidence of extrapyramidal adverse effects compared with conventional antipsychotics. Risperidone is indicated for irritability associated with autistic disorder in children and adolescents aged 6-16 years.

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Aripiprazole (Abilify)

 

The mechanism of action of aripiprazole is unknown, but it is hypothesized to work differently from other antipsychotics. Aripiprazole is thought to be a partial dopamine (D2) and serotonin (5-HT1A) agonist and to antagonize serotonin (5-HT2A). Additionally, no QTc interval prolongation has been reported in clinical trials.

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Contributor Information and Disclosures
Author

Sufen Chiu, MD, PhD  Assistant Clinical Professor (Volunteer Faculty), University of California, Davis, School of Medicine; Consulting Staff, Child and Adolescent Psychiatry of Sacramento County; Consulting Staff, Sutter Center for Psychiatry; Consulting Staff, Transcultural Wellness Center

Sufen Chiu, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychiatric Association, California Medical Association, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Randi Jenssen Hagerman, MD, FAAP  Professor of Pediatrics, Medical Director MIND Institute, Endowed Chair in Fragile X Research, Division of Developmental/Behavioral Pediatrics, University of California Davis Medical Center

Randi Jenssen Hagerman, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics, Society for Developmental and Behavioral Pediatrics, Society for Pediatric Research, and Western Society for Pediatric Research

Disclosure: Roche Grant/research funds PI on study; Novartis Grant/research funds PI on study; Seaside therapeutics Grant/research funds PI on study; Johnson and Johnson Grant/research funds PI on study; Forest Grant/research funds PI on study; curemark Grant/research funds PI on study

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Young child with fragile X syndrome who does not have obvious dysmorphic features.
 
 
 
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