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Biomedical subjects

M G Aman

Publications and source records attributed to M G Aman.

At least 19 recordsLinked to original sources
PubMed2000

Pharmacotherapy of disorders in mental retardation.

This is a review of pharmacotherapy in children and adolescents with mental retardation from the perspective of DSM and ICD disorders. The existing research is reviewed in young people with mental retardation but, when data are lacking, we examined the literature from adults with mental retardation and from typically-developing children. The literature is discussed for each of the following disorders: ADHD, anxiety disorders, bipolar disorder, conduct disorder, depression, enuresis, schizophrenia, self injury, and tics and movement disorders. With the possible exception of ADHD, there is a woeful lack of empirical data on most of these disorders in young people with mental retardation. Clinicians will often be forced to extrapolate from data on adults having mental retardation and from typically-developing children. The best policy is probably to treat such patients cautiously, while gathering data on the effects of such therapy in the hopes of beginning a data base.

Adolescent↗
PubMed2000

Assessment in multisite randomized clinical trials of patients with autistic disorder: the Autism RUPP Network. Research Units on Pediatric Psychopharmacology.

Assessment of autistic disorder (autism) symptoms, primary and secondary, poses more challenging problems than ordinarily found in multisite randomized clinical trial (RCT) assessments. For example, subjects may be uncommunicative and extremely heterogeneous in problem presentation, and current pharmacological treatments are not likely to alter most core features of autism. The Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved some of these problems during the design of a risperidone RCT in children/adolescents. The inappropriateness of the usual anchors for a Clinical Global Impression of Severity (CGI-S) was resolved by defining uncomplicated autism without secondary symptoms as a CGI-S of 3, mildly ill. The communication problems, compromising use of the patient as an informant, were addressed by several strategies, including careful questioning of care providers, rating scales, laboratory tests, and physical exams. The broad subject heterogeneity requires outcome measures sensitive to individual change over a wide spectrum of treatment response and side effects. The problems of neuropsychologically testing nonverbal, lower functioning, sometimes noncompliant subjects requires careful instrument selection/adaptation and flexible administration techniques. The problems of assessing low-end IQs, neglected by most standardized test developers, was resolved by an algorithm of test hierarchy. Scarcity of other autism-adapted cognitive and neuropsychological tests and lack of standardization required development of a new, specially adapted battery. Reliability on the Autism Diagnostic Interview (currently the most valid diagnostic instrument) and other clinician instruments required extensive cross-site training (in-person, videotape, and teleconference sessions). Definition of a treatment responder required focus on individually relevant target symptoms, synthesis of possible modest improvements in many domains, and acceptance of attainable though imperfect goals. The assessment strategy developed is implemented in a RCT of risperidone (McDougle et al., 2000) for which the design and other methodological challenges are described elsewhere (Scahill et al., 2000). Some of these problems and solutions are partially shared with RCTs of other treatments and other disorders.

Antipsychotic Agents↗
PubMed2000

Pharmacotherapy for hyperactivity in children with autism and other pervasive developmental disorders.

We reviewed pharmacological treatments used in children with autism and PDD-NOS who present with hyperactive symptoms. Some 41 studies were identified from the following drug categories: antipsychotics (n = 13), serotonin reuptake inhibitors (n = 3), antianxiety drugs (n = 4), psychostimulants (n = 10), alpha adrenergic agonists (n = 2), opiate blockers (n = 7), and other drugs (n = 2). Empirical evidence for significant reductions in hyperactive symptoms was strongest for the antipsychotics, psychostimulants, and naltrexone. Most studies have focused on the reduction of overactivity, and more emphasis needs to be placed on distractibility and attentional variables. A theoretical model was proposed in which participants' attentional performance may be used to predict clinical response to psychostimulants. More carefully controlled and comprehensive studies of hyperactivity are badly needed in these children.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. Background and rationale for an initial controlled study of risperidone.

This article has reviewed the background and rationale for the choice of risperidone as the first drug to be studied by the RUPP Autism Network. Risperidone has potent effects on 5-HT and DA neuronal systems, both of which have been implicated in the pathophysiology of autism. Unlike the typical antipsychotics, haloperidol and pimozide, which have been shown to be effective for reducing many of the maladaptive behaviors associated with autism, risperidone's 5-HT2A/DA D2 ratio of receptor blockade appears to produce a lower risk of acute and chronic extrapyramidal side effects, as well as enhanced efficacy for the "negative" symptoms of autism. Indirect clinical and preclinical evidence supports the use of risperidone to treat impaired social behavior, interfering repetitive phenomena, and aggression, targets of pharmacotherapy for many patients with autism. Numerous published open-label trials in children and adolescents with autism and related PDDs and one double-blind, placebo-controlled study in adults suggest that risperidone has promise for the treatment of children and adolescents with autism. Because most of these studies have been short-term, open-label trials in small samples, however, a large-scale controlled study of risperidone in children and adolescents with autism is needed to confirm these results. Finally, because it is likely that children who demonstrate short-term benefit from risperidone will remain on the medication indefinitely, the longer-term effectiveness and safety of risperidone in this population also needs to be determined. The design of this study and the assessments used are described separately.

Adolescent↗
PubMed1997

The international consensus process on psychopharmacology and intellectual disability.

The present authors invited 115 scientists, practitioners and consumers from 11 nations to form an international consensus panel on best practices and clinical effects regarding psychoactive medicines and intellectual disability. Co-sponsors included the American Association on Mental Retardation, the American Psychiatric Association, the American Psychological Association, the National Institute of Mental Health, the National Association on Dual Diagnosis and The Arc of the United States. The panel developed 21 reports that were revised to reflect comments from 351 participants at a 1995 Ohio State University conference in Columbus, OH, USA. The reports will be published as chapters in a forthcoming book entitled Psychotropic Medication and Developmental Disabilities: The International Consensus Handbook. The need for research and training programmes is discussed.

Diagnostic Errors↗
PubMed1997

Fenfluramine and methylphenidate in children with mental retardation and borderline IQ: clinical effects.

A double-blind, placebo-controlled, crossover study of methylphenidate (0.4 mg/kgday) and different doses of fenfluramine (1.0, 1.5, or 2.0 mg/g/day) in children with mental retardation or borderline IQ and ADHD was conducted. Parents, teachers, examiners, and physicians rated the children. There were relatively few significant drug effects by condition. When the optimal fenfluramine dose for each child was compared with placebo and methylphenidate, significant improvements occurred for fenfluramine on several parent and teacher subscales; teachers rated the children as somewhat improved with methylphenidate. The highest dose of fenfluramine produced more behavior compliance but apparently at the cost of cognitive efficiency. Most side effects (drowsiness, dizziness, anorexia) occurred with fenfluramine. Both drugs appear to be effective treatments for children with ADHD and mental retardation, although there is a possible neurotoxic action with fenfluramine. We recommend a gradual phase-in of fenfluramine dosage, up to 1.5 mg/kg/day, for most children.

Adolescent↗
PubMed1995

Consumer satisfaction with involvement in drug research: a social validity study.

OBJECTIVE: To assess the social importance and personal benefit attached to involvement in drug research for participating families. METHOD: Parents of children with mental retardation or borderline IQ who took part in two drug studies were surveyed by mail 4 weeks after their involvement. The questionnaire addressed the acceptability of study procedures and satisfaction with study outcomes ("social validity"). RESULTS: Forty (63.5%) of 63 families responded to the survey. In all, 83% felt that their questions were satisfactorily answered regarding the role of medication for their children, and 88% were satisfied with the individual conclusions reached regarding pharmacotherapy for their children. Virtually all parents believed that the study assessments used were important, and 88% indicated that they would join the study again if faced with the same choices. CONCLUSIONS: These parents appear to have found the research experience to be of practical benefit to them, and they were generally positive about their experiences. As this seems to be the only published study of the social or perceived validity of drug research, more surveys of this type are needed to assess consumer reactions to a broader array of research experiences.

Adolescent↗
PubMed1995

Psychotropic and anticonvulsant drugs in subjects with autism: prevalence and patterns of use.

OBJECTIVE: To survey the prevalence and patterns of psychotropic and anticonvulsant medication and vitamin treatments in patients with autism. METHOD: Caregivers of 1,595 index cases were sent survey questionnaires by mail, and repeat questionnaires were sent twice if no reply was received. RESULTS: A total of 838 care providers (53%) responded to the survey. In all, 33.8% of the sample was taking some psychotropic drug or vitamin for autism or associated behavioral/psychiatric problems. A total of 19.2% reported having epilepsy, but only 13.2% were taking anticonvulsant drugs. More than 50% of the sample was taking some psychotropic, antiepileptic, vitamin, or "medical" agent. Of the agents taken, care providers were most satisfied with anticonvulsants, antidepressants, and stimulants. The use of each drug group was analyzed with respect to subject and demographic variables to evaluate medication patterns within this population. CONCLUSION: As in the often related clinical population of mental retardation, psychotropic medication appears to be heavily used in patients with autism.

Adolescent↗
PubMed1995

Psychotropic drugs in group homes: prevalence and relation to demographic/psychiatric variables.

All 1,101 clients residing in over 120 group homes of a residential services agency were surveyed on one date for presence of psychotropic medication. In all, 27% received one or more psychotropic drugs for behavioral or emotional disorders. Disorders and target behaviors listed for each drug group were examined and the relations between drug groups and diagnostic/demographic variables analyzed. In addition, logistic regression analyses were used to examine subject variable/drug relations further and the likelihood of receiving a specific class of medication given the presence of a subject variable. Certain physical and sensory handicaps were associated with less medication use. Generally speaking, the existence of DSM diagnoses (especially psychosis and mood disorder) and certain target behaviors were associated with greater medication use. In the main, medication use was consistent with known or presumptive indications for the respective drug groups, although unestablished applications were also observed.

Adolescent↗
PubMed1995

The Aberrant Behavior Checklist-Community: factor validity and effect of subject variables for adults in group homes.

The factor validity of the new Aberrant Behavior Checklist-Community (ABC-C) was determined with 1,040 group home residents. Exploratory factor analysis indicated that the factor structure derived from the original ABC appears to be valid for the ABC-C when used with this population. Coefficients of congruence showed a high level of concordance with the original factor structure, and internal consistency continued to be high for each of the five subscales. Analyses for the effects of age, gender, and level of mental retardation indicated that some correction is appropriate for each of these variables when scoring the ABC-C. Further analyses explored the effects of subjects variables such as visual and auditory handicaps and the presence of epilepsy or Down syndrome. Psychotropic medication use was often associated with subscale score differences. The original ABC factor structure appears valid for scoring the ABC-C with community-based adults, at least those living in group homes.

Adolescent↗
PubMed1994

Ratings of hyperactivity and developmental indices: should clinicians correct for developmental level?

This study assessed the relationship between parent and teacher ratings of hyperactivity and developmental indices (chronological age, IQ, and mental age) in two groups of children. Subjects were drawn separately from two psychiatric clinics: (a) a general clinical sample, largely of normal ability, seen for a multitude of psychiatric and behavioral problems, and (b) a developmental clinic sample, comprising children with cognitive delays and seen for ADHD or the absence of ADHD. The results showed consistent negative correlations between chronological age and severity of hyperactivity symptoms; however, these occurred mainly within the developmental clinic sample. Only 4 of 27 comparisons (15%) between mental age and hyperactivity ratings (all confined to the developmentally delayed sample) showed a significant correlation. When chronological age was first partialled out, the correlations between ratings of hyperactivity and mental age ceased to be significant. Findings suggest that chronological age should be taken into consideration when behavior ratings are used to assess cognitively delayed children for ADHD. However, the results do not support guidelines stating that mental age must be used to determine which norms should be applied when such children are evaluated clinically.

Adolescent↗
PubMed1993

Fenfluramine and methylphenidate in children with mental retardation and attention deficit hyperactivity disorder: laboratory effects.

Twenty-eight children took part in a double-blind, placebo-controlled, crossover study of fenfluramine and methylphenidate. Fenfluramine dosage was gradually increased to a standardized dose of 1.5 mg/kg per day, whereas methylphenidate was given in doses of 0.4 mg/kg per day. The children were assessed on laboratory tests of selective and sustained attention, visual matching, and color matching, during which seat activity was monitored automatically. Results showed fenfluramine to be superior to placebo on the memory task, whereas methylphenidate reduced commission errors on a continuous performance test. Methylphenidate caused shorter response times, and fenfluramine caused increases, on two of the tests. Examiner behavior ratings indicated significant improvements with both drugs on the domains of attention, activity level, and mood. These findings, together with those from a companion clinical study, suggest that the drugs may have contrasting mechanisms of action, but both appear to have useful clinical effects in these children.

Adolescent↗
PubMed1993

Fenfluramine and methylphenidate in children with mental retardation and ADHD: clinical and side effects.

Each of 28 nonautistic children with attention-deficit hyperactivity disorder and mental retardation received placebo, methylphenidate (0.4 mg/kg/day), and fenfluramine (gradually increased to 1.5 mg/kg/day) for 4 weeks each in a double-blind, crossover design. Teacher ratings indicated significant improvements with both active drugs on subscales designated as Conduct Problem, Hyperactivity, and Irritability, but methylphenidate alone produced improvements on an Inattention subscale. Parent ratings indicated significant improvements with both drugs on subscales labeled Hyperactivity, Motor Excess, and Conduct Problem. Fenfluramine alone caused improved parent ratings on Irritability and Inappropriate Speech, and on Conners' Abbreviated Symptom Questionnaire. Unlike a previous study, subgroup analyses failed to show a significantly better clinical response to methylphenidate for subjects with higher mental ages, although children with higher IQs responded better than those with IQs less than 45. The active drugs had contrasting effects on heart rate and blood pressure. Fenfluramine caused significant weight reductions relative to both placebo and methylphenidate. These findings suggest that both methylphenidate and fenfluramine have useful, but somewhat different, clinical effects in certain children with attention-deficit hyperactivity disorder and mental retardation.

Adolescent↗
PubMed1993

Efficacy of psychotropic drugs for reducing self-injurious behavior in the developmental disabilities.

Self-injurious behavior (SIB) is a serious and moderately prevalent problem behavior among developmentally disabled persons, and it frequently leads to treatment with psychotropic medication. The empirical literature relating to the efficacy of pharmacological intervention is comprehensively reviewed. The rationales for using some "newer" agents, such as serotonin reuptake blockers, opiate blockers, and beta-adrenergic blockers are described. In general there are insufficient data to draw conclusions about specific agents. Evidence for a possible role in managing SIB is strongest for thioridazine, lithium carbonate, and the opiate antagonists. However, further research is needed to define the specific indications, if any, for each of these. Impediments to past research are discussed, possible refinements are offered for future research, and recommendations for treatment are offered.

Adrenergic beta-Antagonists↗
PubMed1993

Biological and environmental risk for poor developmental outcome of young children.

A cross-sectional retrospective study was conducted to develop and field test a state-wide screening method for identifying children at risk for developmental problems. Families of 2.5- to 3-year-old children were sampled from the Ohio birth certificate register. Standardized telephone interviews were conducted with 1,601 parents concerning home environment and demographic characteristics. Developmental delay, the outcome variable, was defined by low scores on an abbreviated Developmental Profile II, which was also administered over the telephone. Obstetric history and health status of the newborns was obtained from birth certificates. By means of logistic regression analysis, we found six independent variables representing environmental and biological determinants.

Child Development↗
PubMed1992

Factor validity and norms for the aberrant behavior checklist in a community sample of children with mental retardation.

The Aberrant Behavior Checklist (ABC) is a 58-item rating scale that was developed primarily to measure the effects of pharmacological intervention in individuals living in residential facilities. This study investigated the use of the ABC in a sample of community children with mental retardation. Teacher ratings on the ABC were collected on 666 students attending special classes. The data were factor analyzed and compared with other studies using the ABC. In addition, subscales were analyzed as a function of age, sex, and classroom placement, and preliminary norms were derived. A four-factor solution of the ABC was obtained. Congruence between the four derived factors and corresponding factors from the original ABC was high (congruence coefficients ranged between .87 and .96). Classroom placement and age had significant effects on subscale scores, whereas sex failed to affect ratings. The current results are sufficiently close to the original factor solution that the original scoring method can be used with community samples, although further studies are needed to look at this in more detail.

Adolescent↗