Long-term efficacy of haloperidol in autistic children: continuous versus discontinuous drug administration.

The aim of this study was to evaluate the long-term efficacy of haloperidol in autistic children and to determine whether discontinuous drug administration was as effective as continuous drug administration. Sixty children, 48 males and 12 females, ages 2.3 to 7.9 years (X 5.1) completed the study. They received haloperidol over a period of 6 months followed by a 4-week drug withdrawal/placebo period. Haloperidol remained effective, and the discontinuous treatment schedule did not diminish its efficacy. Children with prominent symptoms of irritability, angry and labile affect, and uncooperativeness were the best responders to haloperidol.

Naltrexone in autistic children: an acute open dose range tolerance trial.

The safety and efficacy of naltrexone was explored in an open acute dose range tolerance trial in 10 hospitalized autistic children, ages 3.42 to 6.50 years (mean, 5.04). Naltrexone was given in ascending doses: 0.5, 1.0, and 2.0 mg/kg/day. Behavioral side effects were observed as early as 1/2 hour after dosing. Ratings on the Children's Psychiatric Rating Scale showed that withdrawal was reduced across all three dose levels; administration of 0.5 mg/kg/day dose resulted in increased verbal production; and the 2.0 mg/kg/day dose resulted in reduction of sterotypies. Mild sedation of brief duration was the only side effect. Electrocardiogram, liver function tests, and all other laboratory studies remained unchanged throughout the study. These preliminary findings require replication in a larger sample of patients under double-blind and placebo controlled condition.

Children with schizophrenia: diagnosis, phenomenology, and pharmacotherapy.

This article presents data on the diagnosis and phenomenology of schizophrenia in 16 hospitalized children, ages 5.5 to 11.75 years. These 16 subjects are the first to complete an ongoing double-blind, placebo-controlled study of haloperidol in children with schizophrenia diagnosed by DSM-III-R criteria. We describe the pharmacologic treatment response of this subsample and compare our diagnostic, phenomenologic, and treatment findings with those of other investigators. Our results show that children under age 12 can be diagnosed with schizophrenia by the same criteria used for adults, that they show comparable clinical symptoms, and that on haloperidol they show improvement in target psychotic symptoms, at least in a short-term inpatient setting.

Scales for the assessment of neuroleptic response in schizophrenic children: specific measures derived from the CPRS.

This article reports the psychometric properties of two scales for rating positive and negative schizophrenic signs and symptoms. These Positive and Negative Syndrome Scales consist of items selected from the Children's Psychiatric Rating Scale (CPRS), which contains items covering a wide range of childhood psychopathology. CPRS rating data were analyzed for 19 schizophrenic children, 16 males and 3 females, mean age 8.9 years (range 5.5-11.7), evaluated in a double-blind, placebo-controlled crossover study of haloperidol. We describe the item composition and coherence of each scale, the interrater reliabilities of clinicians using the scales, and the sensitivity of the scales for resolving treatment response. Schizophrenic children showed both positive and negative signs and symptoms, and both improved with neuroleptic treatment.

Haloperidol in schizophrenic children: early findings from a study in progress.

This report presents preliminary findings in an ongoing double-blind, placebo-controlled study of the safety and efficacy of haloperidol in hospitalized schizophrenic children. The subjects are diagnosed schizophrenic by DSM-III-R criteria and admitted to the Bellevue Hospital Children's Inpatient Psychiatric Unit. The study is 10 weeks in duration and employs a crossover design. After a 2-week placebo baseline period, the subjects enter double-blind treatment for 8 weeks, by random assignment receiving either haloperidol for 4 weeks followed by placebo for 4 weeks, or alternatively, placebo for 4 weeks followed by haloperidol for 4 weeks. Dosage, regulated individually, ranges from 0.5 to 10.0 mg/day. To date, of an anticipated 20 subjects, 12 have completed the study. These children, 9 boys and 3 girls, were ages 5.5 to 11.75 years upon study entry. Haloperidol was superior to placebo for reduction of target symptoms with optimal haloperidol dose of 0.5 to 3.5 mg/day (0.02-0.12 mg/kg/day).

Saliva and serum lithium monitoring in hospitalized children.

Serum and saliva lithium levels are presented for 30 inpatients, ages 5.12 to 11.95 years, diagnosed as having conduct disorder of the undersocialized aggressive type. Maintenance doses of lithium carbonate ranged from 600 mg to 1,500 mg/day. Serum and saliva lithium levels were significantly correlated at optimal dose (r = .78, p less than .001) and overall (r = .83, p less than .001), lending support to the use of saliva lithium levels as an adjunct to serum lithium determinations. However, because saliva/serum lithium ratios reveal wide ranges between subjects, the use of saliva levels is limited, and laboratory assessments should be combined with careful clinical monitoring.

Differentiation of stereotypies from neuroleptic-related dyskinesias in autistic children.

Videotapes of autistic children with stereotypies and/or neuroleptic-related dyskinesias were shown to three experienced raters blind to the children's medication treatment status and history, if any, of neuroleptic exposure. Upon observation of the videotapes, stereotypies and neuroleptic-related dyskinesias were not well differentiated from each other. These results emphasize the importance of assessing and documenting baseline abnormal movements before patients receive neuroleptic therapy. Meticulous baseline evaluation, integral to all patient care, is of particular concern in treating patient populations that often show abnormal movements unrelated to neuroleptic exposure. Such movements can be mistaken clinically for neuroleptic-related dyskinesias and, in the absence of baseline data for comparison, can be misdiagnosed as such.

Stereotypies and tardive dyskinesia: abnormal movements in autistic children.

Baseline stereotypic movements in 224 autistic children were studied as well as their relationship to certain demographic variables and measures of overall symptomatology and severity of illness. Prediction of haloperidol-related dyskinesias with measures of stereotypies and demographic variables was also attempted. Stereotypies were present in at least mild form in most children, with most showing moderate severity. Most stereotypies were in the orofacial area. I.Q. was found to be negatively related to stereotypies. Furthermore, across methods of assessment, severity and frequency of stereotypies were found to be positively related to overall symptomatology and severity of illness. No significant predictors of development of dyskinesias were found.