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Aggression and self-injurious behavior (SIB) are common in children with autism spectrum disorder (ASD) and impair adaptive function.
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Typologies such as proactive (cold) aggression and reactive (hot) aggression have been described, but not previously applied to ASD.
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This study identified subtypes of aggression in a sample of 206 children with ASD (aged 5–17 years) who participated in 2 risperidone trials conducted by the Research Units on Pediatric Psychopharmacology Autism Network.
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Five subtypes
Child and Adolescent Psychiatric Clinics of North America
Examination of Aggression and Self-injury in Children with Autism Spectrum Disorders and Serious Behavioral Problems
Section snippets
Key points
Setting and Subjects
Subjects were enrolled in 1 of 2 randomized clinical trials conducted by the RUPP Autism Network. The first study was an 8-week, double-blind, placebo-controlled trial of risperidone in 101 children 5 to 17 years old with autistic disorder. The second study was a 24-week randomized trial of risperidone only versus risperidone plus parent training in 124 children with ASDs from 4 to 13 years of age. Medication dosing and blinded assessments in these two studies were virtually identical for the
Sample Characteristics
Because of missing or incomplete PTPs for 19 subjects at baseline, the present analyses included 206 children (174 boys, 32 girls). Table 2 presents demographic and clinical characteristics for this sample.
Inter-rater agreement on the classification of aggression subtypes was good (kappa, 0.77; 95% confidence interval [CI], 0.71, 0.84]). Table 3 presents the frequency of the aggression subtypes: hot aggression only (n = 65), cold aggression only (n = 32), SIB only (n = 33), aggression plus SIB
Discussion
This study was designed to identify subtypes of aggression in a sample of children with ASD who participated in 2 multisite trials of risperidone funded by the National Institute of Mental Health (NIMH) conducted by the RUPP Autism Network.12, 15 The classification of aggression subtypes was based on a semistructured narrative derived from parent-reported chief complaint at baseline in each study. Five subtypes of aggression emerged: hot aggression only, cold aggression only, SIB only,
Summary
The results of this study support, but do not confirm, the subtypes of hot and cold aggression in children with ASDs. These subtypes, which were adapted from previous studies on aggression outside the realm of ASDs, may be useful to guide further study on biological mechanisms and individualized treatment. Overall, our data suggest that aggression subtypes respond similarly to treatment with risperidone. Future studies could examine whether targeting the inadequate emotion regulation of
Acknowledgments
NIMH: Ann Wagner, PhD. Yale: James Dziura, PhD; Lily Katsovich, MS, MBA; Yanhong Deng, MPH; Allison Gavaletz, BA.
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Statistical Analysis: Victoria Hallett, PhD; Lawrence Scahill, MSN, PhD.
This work was funded by National Institute of Mental Health by the following RUPP grants: Yale, U10MH66764; Indiana University, U10MH66766; Ohio State University, U10MH66768. Johnson & Johnson Pharmaceutical Research & Development provided active risperidone for the study. This publication was also supported by the Yale CTSA, UL1 RR024139; IU CTSA, UL1 RR025761; OSU CTSA, UL1 RR025755 from the National Center for Research Resources.
Disclaimer: The opinions and assertions contained in this article are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services, the National Institutes of Health, or the National Institute of Mental Health.
Disclosures: Dr Scahill, Roche, consultant; Bracket, consultant, BioMarin, consultant; speaker’s honoraria from the Tourette Syndrome Association; Roche, research support; Pfizer, research support; research support and study drug supply from Shire. Dr Aman, Roche, consultant; Bristol-Meyers Squibb, consultant, research grant; Forest, consultant; Pfizer, consultant; Supernus, consultant; Johnson & Johnson, research grant. Dr McDougle, study drug supply from Shire. Dr McCracken, research support from Seaside Therapeutics, Roche, and Otsuka; consultant income from Novartis, BioMarin, PharmaNet, and Noven; speaker’s honoraria from the Tourette Syndrome Association; research support and study drug supply from Shire. Dr Arnold, AstraZeneca, advisory board; Biomarin, advisory board; CureMark, research funding; Forest, research funding; Lilly, research funding; Noven, advisory board; Seaside therapeutics, advisory board; Shire, research funding. Dr Tierney, BioMarin, consultant. Dr Handen has received research support from Eli Lilly, Curemark, and Bristol-Myers Squibb. Drs Hallett, Lecavalier, Sukhodolsky, Bearss, Johnson, Swiezy, and Vitiello report no financial relationships with commercial interests.