The effectiveness of risperidone in the treatment of three children with feeding disorders.

Children with histories of extensive medical interventions in early childhood, especially those involving the gastrointestinal tract, are at-risk for residual feeding problems long after the medical issues have resolved. This case series describes the inpatient multidisciplinary treatment of 3 consecutive preadolescent children (ages 9, 8, and 7 years) admitted to our rehabilitation facility. Each child was admitted with a severe feeding disorder and histories of failure-to-thrive (FTT) that had required enteral nutritional interventions. Each child also had comorbid anxiety and mood symptoms. The addition of risperidone to behavioral and psychopharmacologic treatments was observed to significantly increase oral intake and accelerate weight gain. In 2 of 3 patients, assistive feeding interventions were successfully discontinued; and in a 3rd patient, enteral nutritional support was reduced by 74%. These cases suggest that risperidone may be a safe and effective adjunctive treatment, when behavioral feeding therapy is not sufficiently successful for children who have chronic and complicated medical and psychiatric presentations.

An intervention to reduce disruptive behaviours in children with brain injury.

This study investigated the effectiveness of a behavioural intervention programme in reducing disruptive behaviours in children with brain injury. The behavioural package included programme rules, a token economy with response cost and mystery motivators. Participants were three male patients in an after-school programme at a rehabilitation hospital who were identified as having both a brain injury and disruptive behaviours in the classroom setting. Two control composites were formed, one with children who behaved appropriately and one with children who behaved in a disruptive manner. This study employed a multiple baseline design across individuals. The participants' disruptive behaviour decreased during the intervention phase by an average of 69%; the effect size of each participant's improvement was 'large'. The comparisons' disruptive behaviour was unchanged. This pronounced decrease in disruptive behaviours for the three participants was maintained in the follow-up phase. This short-term, easily implemented package altered important programme and social behaviours positively, were well received by children and staff and resulted in long-term improvements to behavioural deficits secondary to brain injury. These results are discussed in terms of theoretical disagreements, methodological issues and practical community-based interventions in brain-injured children.