Kids with Sickle Cell Disease More Likely to Have Physical and Developmental Health Problems

The first national estimate on the health status of children with sickle cell disease revealed that black children with sickle cell disease are more likely to have intellectual disabilities, hearing deficits, and frequent severe headaches or migraines than black children without sickle cell disease. The study by the Centers for Disease Control and Prevention (CDC), “Health Status and Healthcare Use in a National Sample of Children with Sickle Cell Disease,” was published in the American Journal of Preventive Medicine.

The study found that black children with sickle cell disease are four times more likely to have fair or poor health status, twice as likely to have recently visited a mental health professional and have received special educational or early intervention services more often compared with black children without sickle cell disease.

Sickle cell disease is a group of red blood cell disorders that is inherited, passed from parents to children. In sickle cell disease, the red blood cells become hard and sticky, and take on a sickle shape. When the C-shaped cells travel through small blood vessels, they clog the vessels and can block blood flow. In addition, the sickled cells die earlier than normal blood cells, which creates a constant shortage of red blood cells.

“In the United States, sickle cell disease is one of the most common genetic disorders; more than 20 percent of children with SCD had recently visited a health care provider such as an optometrist or an ophthalmologist, and had more than one visit to the emergency department in the past year,” said Sheree Boulet, DrPH, with CDC’s Division of Blood Disorders. “The findings of this study emphasize the importance of screening children with sickle cell disease for thinking ability, hearing, and vision problems.”

Further, despite the increased use of health care services, the data showed that more parents indicated that they could not get an appointment for their child soon enough (10.5 percent, compared to 3.9 percent of parents whose children did not have SCD), reported waiting too long in the doctor’s office (8.7 percent versus 4 percent), and could not get through to their doctor on the telephone (7.5 percent versus 1.8 percent).

“This study gives a better insight into the types of disabilities children with sickle cell disease have and can help health care providers plan comprehensive treatments for children with the disease,” said Dr. Boulet.

The study analyzed data from the 1997–2005 National Health Interview Surveys (NHIS) to describe health status and health services use among black children 0-17 years of age with SCD.  The NHIS has monitored the health of the nation since 1957; it is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). NHIS data on a broad range of health topics are collected through personal household interviews.

Source: Centers for Disease Control (CDC), March 23, 2010

Community-Acquired MRSA’s Increasing Prevalence in Pediatric Patients

Once considered a hospital anomaly, community-acquired infections with drug-resistant strains of the bacterium Staphylococcus aureus now turn up regularly among children hospitalized in the intensive-care unit, according to research from the Johns Hopkins Children’s Center.

The Johns Hopkins Children’s team’s findings, to be published in the April issue of the journal Emerging Infectious Diseases, underscore the benefit of screening all patients upon hospital admission and weekly screening thereafter regardless of symptoms because MRSA can be spread easily to other patients on the unit.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a virulent subset of the bacterium and impervious to the most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in ill people or in those with weakened immune systems, it can lead to invasive, sometimes fatal, infections.

In 2007, The Johns Hopkins Hospital began screening all patients upon admission and weekly thereafter until discharge. Some states have made patient screening mandatory but the protocols vary widely from hospital to hospital and from state to state.

“MRSA has become so widespread in the community, that it’s become nearly impossible to predict which patients harbor MRSA on their body,” says lead investigator Aaron Milstone, M.D., M.H.S., a pediatric infectious disease specialist at Hopkins Children’s.

“Point-of-admission screening in combination with other preventive steps, like isolating the patient and using contact precaution, can help curb the spread of dangerous bacterial infections to other vulnerable patients.”

The new Johns Hopkins study found that 6 percent of the 1,674 children admitted to the pediatric intensive-care unit (PICU) at Hopkins Children’s between 2007 and 2008 were colonized with MRSA, meaning they carried MRSA but did not have an active infection. Of the 72 children who tested positive for MRSA, 60 percent harbored the community-acquired strain and 75 percent of all MRSA carriers had no previous history or MRSA. MRSA was more common in younger children, 3 years old on average, and among African-American children. The reasons behind the age and racial disparities in MRSA colonization remain unclear, the investigators say. Patients with MRSA had longer hospital stays (eight days) than MRSA-free patients (five days) and longer PICU stays (three days) than non-colonized patients (two days).

Eight patients who were MRSA-free upon admission became colonized with MRSA while in the PICU. Of the eight, four developed clinical signs of infection, meaning that the other four would have never been identified as MRSA carriers if the hospital was not performing weekly screenings of all patients.

The research was funded in part by the National Institutes of Health, the Thomas Wilson Sanitarium for Children in Baltimore and by the Centers for Disease Control and Prevention.

Source: John Hopkins Medicine (March 26, 2010)

HIV May Be Transmitted via Pre-Chewed Food

Researchers have uncovered the first cases in which HIV almost certainly was transmitted from mothers or other caregivers to children through pre-chewed food. The source of HIV in the pre-chewed food was most likely the infected blood in the saliva of the people who pre-chewed the food before giving it to the children. The researchers said their findings suggest that HIV-infected mothers or other caregivers should be warned against giving infants pre-chewed food and directed toward safer feeding options.

The cases indicate that physicians and clinics should routinely include questions about pre-chewing food in their health screening of infant caregivers who have HIV or are suspected of the infection. Also, possible cases of HIV transmission through pre-chewed food should be reported to public health agencies to help increase understanding of the prevalence of such transmission.

Led by Aditya Gaur, M.D., of St. Jude Children’s Research Hospital, with colleagues from St. Jude (Marion Donohoe, CPNP), the University of Miami (Charles Mitchell, M.D., and Delia Rivera, M.D.) and the Centers for Disease Control and Prevention (Kenneth Dominguez, M.D., Marcia Kalish, Ph.D., and John Brooks, M.D.), the researchers published their findings in the August 2009 issue of the journal Pediatrics. Gaur is an assistant member of the St. Jude Infectious Diseases department.

Giving infants pre-chewed food has been reported to transmit infections such as streptococcus and the hepatitis B virus, Gaur said. However, until these cases there was no evidence that the blood-borne HIV could be similarly transmitted. The source of blood in the saliva of the person pre-chewing the food for the child may likely have been visible or microscopic bleeding from the gums or some other part of the mouth, he added.

In their paper, the researchers described three cases in which pre-chewed food was likely the source of HIV transmission to infants.

The case that led to this published report was a 9-month-old infant who was referred to St. Jude because she was HIV positive after earlier tests had been negative.

“Her HIV-positive mother had not breastfed her, and further investigation had ruled out transmission by blood transfusion, injury or sexual abuse,” Gaur said. Also, genetic testing, led by Kalish at the CDC, showed that the daughter had been infected with the same HIV strain as the mother.

“Fortunately, the St. Jude nurse practitioner, Marion Donohoe, was very thorough in her questioning about feeding practices, and she asked about pre-mastication. It turned out this mother had fed her daughter pre-chewed food,” Gaur said.

When Gaur contacted Dominguez at the CDC about the possible case of transmission via pre-chewed food, the center alerted him to two similar cases previously reported by senior author Mitchell and colleague Rivera from the University of Miami. Those cases were not reported to the public at the time because of the lack of sufficient evidence of transmission via pre-chewed food. One case involved pre-chewing by an HIV-infected mother, and the other an HIV-infected aunt who was the caregiver.

Gaur said that information in the three cases suggests that one factor aiding such transmission was mouth bleeding in the caregiver, as well as in the infant due to teething or infection. He also said caregivers’ lack of adherence to their own drug-treatment regimens probably increased their blood HIV levels, increasing the likelihood of transmission.

“These three cases are persuasive enough that they justify cautioning HIV-positive caregivers against giving infants pre-chewed foods,” Gaur said. “Also, we hope increased awareness of this possible mode of transmission will bring more cases to light and more thorough studies, which can either substantiate or refute this transmission route.” Also important, Gaur said, will be the results of surveys now being conducted in collaboration with other research groups in the United States and abroad to determine the extent of infant feeding using pre-chewed food.

The findings do not warrant a blanket recommendation against pre-chewed food for infants, the researchers emphasized. The practice, which has been reported from many parts of the world including the United States may be integral to providing adequate infant nutrition and grounded in culture and tradition. On a global level, educating HIV-positive caregivers will require cognizance of culturally sensitive issues and potential nutritional consequences linked to pre-chewing, the investigators said. The findings also do not imply that HIV can be transmitted through saliva during oral contact such as kissing. In the cases the researchers studied, HIV transmission was likely enabled by bleeding gums or open mouth sores.

“Importantly, this report does not challenge the accepted belief that saliva does not carry HIV and that transmission does not occur in kissing,” Gaur said. “The exception is that transmission can occur when the people involved have damaged mucosa in their mouths, and blood is mixed with the saliva.”

Source: St. Jude Children’s Research Hospital; Pediatrics, August, 2009

Reduced Dosage for Pneumococcal Vaccine in Infants Effect, Says Study

Infants who received two or three primary doses of the 7-valent pneumococcal conjugate vaccine (PCV-7) both had a decreased rate of carrying pneumococcal microorganisms that can cause pneumonia and other infections, compared to infants who were not vaccinated, according to a study in the July 8 issue of JAMA.

Crowded infant vaccine schedules and less favorable cost-effectiveness calculations have prompted exploration of reduced-dose vaccine schedules other than the currently recommended 3 + 1-dose schedule of PCV-7, which consists of 3 primary doses before age 6 months followed up by a booster vaccination in the second year of life, according to background information in the article. Difficulty in implementing the 3 + 1-dose schedule in developing countries is another reason for exploring reduced schedules. The effects of reduced-dose schedules of PCV-7 on pneumococcal carriage in children are largely unknown.

Elske J. M. van Gils, M.D., of the University Medical Center Utrecht, the Netherlands, and colleagues examined the effects of a 2-dose and 2 + 1-dose PCV-7 schedule on nasopharyngeal (upper part of the throat behind the nose) pneumococcal carriage in young children. The randomized trial included 1,003 healthy newborns and 1 of their parents in a general community in the Netherlands, with follow-up to age 24 months. Infants were randomly assigned to receive 2 doses of PCV-7 at 2 and 4 months; 2 + 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (control group).

No significant differences in vaccine serotype (a strain of microorganisms having a set of antigens in common), nonvaccine serotype, and overall pneumococcal carriage were observed at 6 months in both vaccine groups compared with the control group. At 12 months, vaccine serotype carriage rates were significantly lower in both vaccine groups compared with the control group, with 25 percent in the 2-dose schedule group, 20 percent in the 2 + 1-dose schedule group, and 38 percent in the control group. A further decrease of vaccine serotype carriage was found at 18 months after 2 + 1-dose schedule and at 24 months after 2 primary doses compared with the control group.

In analysis comparing the 2-dose and 2 + 1-dose schedules, the researchers observed a significant difference in vaccine serotype carriage at 18 months with 24 percent vaccine serotype carriage in the 2-dose schedule group compared with 16 percent in the 2 + 1-dose schedule group. At 24 months, the estimates for vaccine serotype carriage in both vaccine groups were at the same level with 15 percent in the 2-dose schedule group and 14 percent in the 2 + 1-dose schedule group, compared with 36 percent in the control group.

“In conclusion, both 2-dose and 2 + 1-dose schedules of PCV-7 significantly reduce vaccine serotype pneumococcal carriage in children. This study supports future implementation of reduced-dose PCV-7 schedules,” the authors write.

Source: JAMA. 2009;302[2]:159-167

Research May Lead to Improved Immune System in Newborn Babies

Newborn babies have immature immune systems, making them highly vulnerable to severe infections and unable to mount an effective immune response to most vaccines, thereby frustrating efforts to protect them.

The World Health Organization estimates that more than 2 million newborns and infants less than 6 months of age die each year due to infection. Researchers at Children’s Hospital Boston believe they have found a way to enhance the immune system at birth and boost newborns’ vaccine responses, making infections like respiratory syncytial virus, pneumococcus and rotavirus much less of a threat.

Ofer Levy, MD, PhD and colleagues in Children’s Division of Infectious Diseases have shown that the newborn immune system functions differently than that of adults, but that one portion of the immune response is fully functional and can be harnessed to boost innate immunity in these tiny infants.

For more than a decade it’s been known that people’s first line of defense against infection is a group of receptors known as Toll-like receptors (TLRs) on the surface of certain white blood cells. Functioning like an early radar system, TLRs detect the presence of invading bacteria and viruses and signal other immune cells to mount a defense. People have 10 different kinds of TLRs, and Levy’s team found that when most of them were stimulated, newborns’ immune responses are very impaired — with one important exception.

One TLR, known as TLR8, triggered a robust immune response in antigen-presenting cells, which are crucial for vaccine responses, suggesting that agents that stimulate TLR8 could be used to enhance immune responses in newborns, perhaps as adjuvants given along with vaccines. With the help of a $100,000 pilot grant from the Bill & Melinda Gates Foundation, Levy’s team is now validating their work in human cells and in animal models, and eventually want to test TLR8 stimulators – some of which are already available — in human babies.

Levy’s team is uncovering other differences in the newborn immune system that could lead to additional targets for drugs or vaccines. “As we better understand the molecular pathways that account for newborns’ susceptibility to infections, we can leverage them to enhance their immune defenses,” Levy says.

The ability to vaccinate newborns — rather than wait until they reach 2 months of age — would provide important global health benefits, adds Levy, whose lab is one of the few in the world to specifically focus on vaccination in newborns. “Birth is a point of contact with healthcare systems,” he says. “If you could give a vaccine at birth, a much higher percentage of the population can be covered.”

Source: Children’s Hospital Boston, June 12, 2009

Adults Should Consider Re-Vaccination for Whooping Cough

“Vaccines are not just for children any more.”

That is the important, and potentially life-saving message, that Geisinger Health System pediatric gastroenterologist William Cochran, M.D., vice chairman of the Janet Weis Children’s Hospital, wants to deliver. And this is a message that comes from personal experience.

“I am a physician, and I didn’t realize that adults needed to be revaccinated for what are considered childhood diseases such as pertussis (whooping cough),” said Dr. Cochran. “And I found that out the hard way – by contracting that very disease.”

According to the Centers for Disease Control and Prevention, pertussis is an acute, infectious cough illness that remains prevalent in the United States despite longstanding routine childhood pertussis vaccination. It is characterized by the unforgettable “whoop” sound made when gasping for breath after a coughing fit. It creates a sticky, thick mucous that makes it difficult to eat, drink and breathe.

This remains an issue because immunity wanes approximately five to 10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to the disease. The CDC reports that since the 1980s, the number of reported pertussis cases has increased steadily, especially among adolescents and adults. And, between 2000-2003 and 2004-2007, there was a 100-percent increase in reported cases of pertussis; there may be as many as 800,000 to 3.3 million adult and adolescent cases of pertussis in any given year.

“This is considered the 100-day cough,” said Lisa Esolen, M.D., system director of Geisinger Infection Control. “This is not a cough that goes away after a few days. At Geisinger alone, we’ve had two pertussis outbreaks within a span of a year, one of which required delivering antibiotics to 105 people who were exposed. That is a significant number. And all it takes is awareness and revaccination to control.”

Dr. Cochran’s experience with the disease, and lengthy and painful recovery, has inspired him to educate adults about the importance of revaccination. “The coughing gets so bad that I can’t get any air. My airway closes until the ‘whoop’ end of the cough occurs. It’s very frightening and extremely painful,” he said. “The CDC recommends that all adults between the ages of 19-64 should be revaccinated, along with healthcare providers. If more adults get their vaccines, then we’ll have more power to stop this horrible disease in its tracks.”

See the CDC website for a schedule of recommended adult vaccinations (PDF).

Source: Geisinger Health System, June 12, 2009

Simple Measures to Decrease Child Pneumonia Deaths

Implementing measures to improve nutrition, indoor air pollution, immunization coverage and the management of pneumonia cases could be cost-effective and significantly reduce child mortality from pneumonia, according to a study led by the Johns Hopkins Bloomberg School of Public Health.

Researchers found that these strategies combined could reduce total child mortality by 17 percent and could reduce pneumonia deaths by more than 90 percent. Pneumonia is a leading cause of death of infants in many developing countries, resulting in 2.2 million deaths each year. The study is published in the June 2009 issue of the Bulletin of the World Health Organization.

The study, conducted in collaboration with the World Health Organization (WHO) and other public health schools, assessed economic aspects of existing child interventions and identified the most efficient pneumonia control strategies. Programs to promote better community-based treatment of pneumonia, promotion of exclusive breastfeeding, zinc supplementation and vaccination for Hib and S. pneumoniae were found to be the most cost-effective interventions. The burning of solid fuels like wood, for cooking and heating, was found to contribute at least 20 percent to the burden of childhood pneumonia.

“The interventions we examined already exist, but are not fully implemented in the developing world. In addition, implementation of these interventions do not require a great deal of new infrastructure to carry out,” said Louis Niessen, MD, PhD, lead author of the study and associate professor in the Bloomberg School’s Department of International Health. “Fully funding and implementing these interventions could bring us a big step closer towards reaching the U.N. Millennium Development Goals.”

“The next step is to assess how donors and countries currently deliver these interventions and want to progress in the coming years,” said Majid Ezzati, PhD, co-investigator of the study and associate professor at the Harvard School of Public Health.

“Comparative impact assessment of child pneumonia interventions” was written by Louis Niessen, Anne ten Hove, Henk Hilderink, Martin Weber, Kim Mulholland and Majid Ezzati. The research was supported by grants from the Netherlands Environmental Assessment Agency, the WHO and the United Nations Children’s Fund.

Source: Johns Hopkins Bloomberg School of Public Health, June 1, 2009

Watching TV May Slow Language Development in Infants

In a new study, young children and their adult caregivers uttered fewer vocalizations, used fewer words and engaged in fewer conversations when in the presence of audible television. The population-based study is the first of its kind completed in the home environment, guided by lead researcher Dimitri A. Christakis, MD, MPH, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute and professor of pediatrics at the University of Washington School of Medicine. “Audible Television and Decreased Adult Words, Infant Vocalizations, and Conversational Turns” was published in the June 2009 issue of Archives of Pediatrics & Adolescent Medicine.

“We’ve known that television exposure during infancy is associated with language delays and attentional problems, but so far it has remained unclear why,” said Christakis. “This study is the first to demonstrate that when the television is on, there is reduced speech in the home. Infants vocalize less and their caregivers also speak to them more infrequently.”

The study looked at infants aged two months to four years old; a total of 329 children were studied. The children wore a small, business card-sized, two ounce digital recorder on random days monthly for up to two years. A specially designed vest with a chest pocket held the recorders at a specific distance from the mouth, and captured everything the child said and also heard during continuous 12 to 16 hour periods. The recorders were removed only for naps, baths, nighttime sleep and car rides. A speech identification software program processed the recorded files to analyze sounds children were exposed to in their environment, as well as the sounds and utterances they made.

Measurements in this study included adult word counts, child vocalizations, and child conversational turns, defined as verbal interactions when a child vocalizes and an adult responds to them vocally (or vice versa) within five seconds.

The study found that each hour of audible television was associated with significant reductions in child vocalizations, vocalization duration, and conversational turns. On average, each additional hour of television exposure was also associated with a decrease of 770 words the child heard from an adult during the recording session. This represented a seven percent decrease in words heard, on average. There were significant reductions in both adult female and male word counts. From 500 to 1,000 fewer adult words were spoken per hour of audible television.

“Adults typically utter approximately 941 words per hour. Our study found that adult words are almost completely eliminated when television is audible to the child,” added Christakis. “These results may explain the association between infant television exposure and delayed language development.” Christakis further adds that this may also explain attentional and cognitive delays, since it has been posed that language development is a critical component of brain development in early childhood.

For purposes of this study, subjects were excluded if they had any diagnosed language delay, or if the primary language spoken at home was not English. Children served as their own experimental controls, meaning that the natural variation within each child’s daily television exposure was compared for each child, looking at the amount of vocalizations and conversational turns that each individual child experienced, on both their high-television days as well as their low-television days. The recordings did not distinguish between foreground television and background television; no determinations were made about whether the children or adults were actively watching the television or it was simply audible in the environment.

The American Academy of Pediatrics’ Committee on Public Education (Pediatrics, 2001) specifically recommends against screen time for children under two years of age, urging more interactive play in its place.

“Since 30 percent of American households now report having the television always on, even when no one is watching, these findings have grave implications for language acquisition and therefore perhaps even early brain development,” added Christakis. “Audible television clearly reduces speech for both infants and their caregivers within the home, and this is potentially harmful for babies’ development. There is simply nothing better for early childhood language acquisition than the spoken and imitated words of caregivers, and every word counts. Television is not only a poor caregiver substitute, but it actually reduces the number of language sounds and words babies hear, vocalize and therefore learn. We are increasingly technologizing infancy, which may prove harmful to the next generation of adults.”

Recorders, vests and software from the LENA Foundation provided data collection. LENA is a language environment analysis system designed to provide parents, clinicians and researchers with information about the language environment of infants and toddlers.

Tips and resources for parents and caregivers include the following recommendations:

For babies:

  • Avoid TV for babies under age two. Choose activities that promote language development and brain growth such as talking, playing, reading, singing and enjoying music.

For children over age two:

  • If you allow TV time, choose age-appropriate programs. Involve older children in setting guidelines for what to watch. Use guides and ratings to help, but beware of unproven claims that programs or DVDs are educational. Even cartoons produced for children can be violent or over stimulating.
  • Limit TV time to no more than two hours per day. Less is better.
  • Keep TV off during meals.
  • Set “media-free” days, and plan other fun things to do.
  • Avoid using TV as a reward.
  • Turn off TV when a chosen program is over. Don’t leave TV on as background filler or while engaging in other activities. When no one is actively watching, turn TV off.
  • Watch TV with your child. Talk about what you see and engage with your child about the content.
  • Keep TVs out of bedrooms.

Source: Seattle Children’s Hospital, June 1, 2009

Autism Drug Citalopram Is Ineffective, Says Study

A drug commonly given to autistic children to reduce repetitive behaviors is ineffective compared to placebo and, in some children, may actually increase repetitive behaviors, the largest study of autistic children to date has found.

“What we found, much to our surprise, is that there was no significant difference in positive response between kids treated with citalopram and kids who received the placebo. And the kids treated with citalopram tended to have more side effects,” said Linmarie Sikich, M.D., a co-author of the study and associate professor of psychiatry in the University of North Carolina at Chapel Hill School of Medicine.

“I cannot emphasize this enough: This was not at all what we expected to see,” Sikich said.

Results of the study, a randomized controlled clinical trial of the drug citalopram, are published in the June 29, 2009 issue of Archives of General Psychiatry. It was funded by the National Institutes of Health and took place at six academic medical centers across the country. Principal investigator and lead author of the study is Bryan H. King, M.D., who began the study at Dartmouth and continued to oversee it there after he moved to the University of Washington, where he is currently director of psychiatry and behavioral medicine at Seattle Children’s Hospital.

Citalopram, which is sold under the brand name Celexa, is one of a class of antidepressant drugs called selective serotonin reuptake inhibitors, or SSRIs. SSRIs are the most frequently used medications for children with autism. They are also used to treat depression, anxiety and obsessive compulsive disorder in both adults and children. Prior to this study there was very little scientific evidence to support the use of SSRIs in autistic children, but some preliminary studies showed promising results for citalopram, Sikich said.

Hypothesizing that citalopram would improve the overall functioning of autistic children and adolescents by reducing repetitive behavior, Sikich and colleagues recruited 149 children ages 5 to 17 to take part in the 12-week trial. Seventy-three received daily doses of liquid citalopram while 76 received daily doses of liquid placebo. Researchers measured the children’s’ response to treatment using the Clinical Global Impression-Improvement scale (CGI-I). They also recorded measures of repetitive behavior and side effects.

At the end of the trial, some children in both groups showed a positive response. However, there was no significant difference between the groups: the positive response in the citalopram group was 32.9 percent versus 34.2 percent in the placebo group. In addition, children in the citalopram group were significantly more likely to experience adverse side effects such as increased energy level, impulsiveness, decreased concentration, hyperactivity, increased repetitive movements and behaviors, diarrhea, insomnia, and dry itchy skin.

The researchers concluded that citalopram “is not an effective treatment” for autistic children with repetitive behaviors. In addition, they wrote, this trial shows that the use of SSRIs in autistic children “is not without risk” and “at present there is insufficient research evidence to merit a clear recommendation regarding the use of SSRIs as a class” for the treatment of repetitive behavior in children with autism spectrum disorders.

“The obvious short term message is, this treatment didn’t work. And that surprised us a great deal,” Sikich says. “But the really important take-home message is that we have to do large, scientifically-sound comparative studies like this to really know whether a specific treatment works and is safe. Simply relying on doctors’ and families’ impressions often leads us to use medications that really don’t work and may do more harm than good” says Sikich.

Safe and effective medication and behavioral treatments are desperately needed to help children with autism realize their potentials and keep from harming themselves or others, Sickish says.

“Well-done studies, using methods like the ones in this study, have shown that another drug, risperidone, is useful in reducing irritability and aggression in children with autism,” she says. “Thus, this study shouldn’t be interpreted as saying all medications don’t help people with autism and are harmful. Instead it says that citalopram doesn’t help most children with autism and is harmful to some children. Clearly we need more research to develop and test other interventions for this important problem.”

People with autism are severely impaired by the disorder and experience major problems with highly repetitive behaviors, often including self-injurious behaviors, communicating and interacting appropriately with others. Frequently the repetitive behaviors keep children with autism from learning in school or participating in age appropriate activities. When it is time to stop the repetitive behavior and begin a new, functional activity, many children with autism become distraught and aggressive. These repetitive behaviors also contribute to the difficulties that make it hard for most people with autism to live independently or work as adults, Sikich says.

In addition to UNC, academic medical centers taking part in the study were Mt. Sinai School of Medicine, North Shore-Long Island Jewish Health System, Dartmouth, UCLA and Yale University.

The study was conducted as part of the NIH-sponsored Studies to Advance Autism Research and Treatment network.

Source: University of North Carolina at Chapel Hill School of Medicine , May 28, 2009