Lowell T. Anderson

A Comparison of Haloperidol and Behavior Therapy and Their Interaction in Autistic Children

Abstract Haloperidol and behavior therapy, and the interaction of the two treatments were critically assessed with respect to their effects on symptoms and language acquisition in 40 autistic children aged 2.6 to 7.2 years. The children were randomly assigned to four treatment groups in a factorial design. The study was placebo controlled and double-blind, using multiple independent raters who assessed treatment effects under three types of rating conditions. Haloperidol was found to be significantly superior to placebo in decreasing certain symptoms, depending on the age group. The combination of the two treatments was most effective in facilitating the acquisition of imitative speech. Optimal dosage of haloperidol ranged from 0.5 to 4.0 mg./day; the most common untoward effect was excessive sedation, which was clearly a function of dosage.

The effects of haloperidol on discrimination learning and behavioral symptoms in autistic children

This double-blind and placebo-controlled clinical trial in autistic children had three objectives: (a) to replicate earlier findings that haloperidol administration is associated with a significant reduction of behavioral symptoms; (b) to further assess its safety when given on a short-term basis: and (c) to assess whether it has an effect on discrimination learning. Forty-five children, 2.02 to 7.58 years old (M=4.49), completed this crossover design, with random assignment to treatment sequences. Haloperidol was shown to be a powerful therapeutic agent when administered for 4 weeks and free of side effects; at doses ranging from 0.25 to 4.0 mg/day (M=0.844), there was a clinically and statistically significant reduction of a variety of symptoms. Under the given conditions, the children failed to learn on either haloperidol or placebo.

Naltrexone in Autistic Children: Behavioral Symptoms and Attentional Learning

OBJECTIVE To assess critically the short-term efficacy and safety of naltrexone in autistic children and its effects on discrimination learning in the laboratory. METHOD A parallel group design was employed. After a 2-week placebo baseline period, children were randomly assigned either to naltrexone or to placebo for a period of 3 weeks followed by a one-week posttreatment placebo period. Multiple raters and rating scales were employed in a variety of conditions. Forty-one children, all inpatients, ages 2.9 to 7.8 years, completed the study. Naltrexone reduced hyperactivity and had no effect on discrimination learning in the laboratory. There was a suggestion that it had a beneficial effect on decreasing self-injurious behavior. Untoward effects were mild and transient. CONCLUSION In the present study, naltrexone significantly reduced only hyperactivity, and no serious untoward effects were observed. The effectiveness of naltrexone in the treatment of autism and self-injurious behavior requires additional assessment in a sample of children with moderate to severe self-injurious behavior.

Self-injury in Lesch-Nyhan disease

Parents of 40 patients with Lesch-Nyhan disease completed a questionnaire detailing developmental history, life course, management, medication, factors influencing variability and topography of self-injury. Several conclusions were reached. Characteristics: Biting was the predominant form, perhaps only because of the difficulty of preventing it. There was considerable variability in self-injury which was strongly related to stress rather than to operant influences. Even though patients could not inhibit self-injury they could predict it and request restraints. Aggression against others was as prevalent as self-injury. Management: Stress reduction, teeth extraction, and physical restraint were the most commonly used management techniques. Behavior modification was of limited efficacy. Benzodiazepines were the most commonly used medications for controlling self-injury. Outcome: The severity of self-injury did not change over years. Age of onset was a predictor of outcome. The earlier the age of onset the worse the self-injury eventually became. The discussion describes research strategies, suggests dimensions along which self-injury can be classified, and highlights behavior not commonly described in patients with Lesch-Nyhan disease.

The Effects of Haloperidol on Learning and Behavior in Autistic Children.

The effects of haloperidol on behavioral symptoms and learning were critically assessed in autistic children in an ongoing double-blind placebo-controlled clinical trial. Children were randomly assigned to haloperidol-placebo-haloperidol or placebo-haloperidol-placebo treatment sequences. Statistically, haloperidol was significantly superior to placebo in reducing behavioral symptoms. In discrimination learning paradigm, children receiving haloperidol learned the discrimination while those on placebo did not. Discrimination attained on haloperidol was retained when the children were switched to placebo.

Efficacy and Safety of Fenfluramine in Autistic Children

Abstract The short-term efficacy and safety of fenfluramine and its effects on discrimination learning in an automated laboratory were critically assessed in 28 autistic children. A parallel group design was employed: following a 2-week placebo baseline period, the children were randomly assigned to fenfluramine or placebo for a period of 8 weeks. Multiple, independent raters and multiple rating scales were used under three conditions. The results failed to show the superiority of fenfluramine over placebo in terms of symptom reduction. Furthermore, fenfluramine had a retarding effect on discrimination learning, employing the same tasks and methodology as in a previous controlled clinical trial. J. Am. Acad. Child Adolesc. Psychiatry , 1988, 27, 4:434–439.

Sensory preference and overselective responding in autistic children.

Five autistic and five normal children were allowed to register a sensory modality preference by bar pressing to select either a visual (slides) or an auditory (music) stimulus. The children were then taught a discrimination between the presence or absence of a compound auditory-visual stimulus (white noise and light). Testing for stimulus overselectivity revealed that the autistic children attended to only one aspect of the compound stimulus. In all cases this was the sensory modality that was selected during the preference test. Significant correlations were obtained between Gesell developmental scores and degree of overselectivity. Normal children registered an equal preference for music and slides and displayed no overselectivity.

Passive avoidance learning in Lesch-Nyhan disease: effect of 1-desamino-8-arginine-vasopressin.

Abstract Previous studies have shown that self-mutilation can be controlled in Lesch-Nyhan children by operant conditioning. Punishment was unsuccessful as a teaching modality. A passive avoidance learning defect has now been confirmed under controlled experimental conditions in 3 children with Lesch-Nyhan disease. The ability to learn was repeatedly and consistently improved in these children by the administration of a vasopressin analogue prior to testing.

Operant analysis of hallucination frequency in a hospitalized schizophrenic

Abstract This paper describes an operant program used to treat a hospitalized schizophrenic patient with frequent visual hallucinations and severe obsessive compulsive behaviors. Both reinforcement and punishment paradigms were utilized in an attempt to eliminate the unusual overt behaviors which defined hallucinatory periods. The data support the hypothesis that hallucinations are subject to operant control. A generalized strategy for extending this procedure to other hallucinating schizophrenics is discussed.

Pharmacotherapy for autistic children: A summary of research.

An overview of research involving pharmacotherapy in infantile autism is presented. Methodological issues relating to experimental design, rating instruments and ecological factors are considered. Classification of infantile autism and diagnostic problems are discussed. Research investigations conducted in order to define diagnostic subgroups in the etiologically heterogeneous population of autistic children are described. An attempt is made to relate biochemical findings to clinical drug response. Recent findings are presented indicating that a potent neuroleptic is able to yield simultaneously significant decrease of behavioural symptoms and improved learning under both clinical and laboratory conditions. The drug can be effective in conservative doses and administered over a period of 14 weeks without untoward effects. New research plans are introduced where attentional learning will be assessed in an operant conditioning paradigm using automated procedures.