The Use of Aripiprazole in Young Children with Autism Spectrum Disorders: The Treatment and 16 Week Follow-Up of a 23-Month-old Male Patient.

Abstract

[Author Affiliation]Ipek Percinel. 1 Department of Child and Adolescent Psychiatry, Osmaniye State Hospital, Osmaniye, Turkey.Kemal Utku Yazici. 2 Department of Child and Adolescent Psychiatry, Firat University Faculty of Medicine, Elazig, Turkey.Address correspondence to: Kemal Utku Yazici, MD, Firat University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Elazig, Turkey, E-mail: dr.kemal.utku@outlook.comTo The Editor:The overall objective of psychopharmacological treatment in patients diagnosed with autism spectrum disorders (ASD) is to target irritability (aggression, tantrums, self-destructive behavior), hyperactivity, impulsivity, and stereotypical behavior (Posey et al. 2008). Although α-2 agonists, mood stabilizers, anticonvulsants, selective serotonin reuptake inhibitors, stimulants, and the typical antipsychotics can be used, atypical antipsychotics are the most common and are the first-line drugs used for treatment (Stigler and McDougle 2008). Studies using randomized, placebo-controlled trials (RCT) have shown that risperidone and aripiprazole were effective in the treatment of irritability, hyperactivity, impulsivity, and stereotypical behavior in patients with ASD (Young and Findling 2015). The number of studies that have investigated the effectiveness of psychopharmacological treatment in patients of a very young age diagnosed with ASD is very limited. Here, we present a treatment and follow-up process of a 23-month-old male patient diagnosed with ASD and treated with aripiprazole for irritability and hyperactivity.Case ReportA 20-month-old male patient was diagnosed with ASD at another center and was included in the rehabilitation program. At the age 23 months, the patient's existing irritability and hyperactivity symptoms worsened; therefore, he was admitted to our clinic. After a risk and benefits ratio evaluation, it was decided to start pharmacological treatment. The body weight of the patient was 13.2 kg. Therefore, a starting risperidone dose (0.25 mg/day [0.019 mg/kg]) was initiated and controlled, while a dose increase was planned. On the 3rd day of treatment, a spasm in the jaws, neck, and back was observed, and we requested a pediatric neurology consultation. The cause was determined to be extrapyramidal side effects. It was thought to be associated with risperidone and therefore, risperidone was discontinued. Immediately, aripiprazole was started (1 mg/day [0.08 mg/kg]). The dose of aripiprazole was increased every two weeks until it reached 3 mg/day (0.22 mg/kg). During the follow-up, the patient was clinically evaluated by using the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC)-Irritability and Hyperactivity subscales, Clinical Global Impressions-Severity (CGI-S) Scale, and Clinical Global Impressions-Improvement (CGI-I) Scale in 2 week intervals. The CGI evaluation was based on behavioral symptoms such as irritability and hyperactivity. At the time of admission, the patient's scale scores were as follows: CARS = 39, ABC-irritability = 30, ABC-hyperactivity = 39, and CGI-S = 5 (markedly ill). By the end of the 16-week-long treatment, the patient showed significant improvements in irritability and hyperactivity symptoms. In addition, a decrease in the CARS score was also observed. The patient tolerated the 3 mg/day aripiprazole treatment well. No side effects were observed, except for moderate levels of sedation. At the end of the 16-week- long treatment, the patient's scale scores were determined as follows: CARS = 31, ABC-irritability = 9, ABC-hyperactivity = 17, CGI-S = 3 (mildly ill), and CGI-I = 2 (much improved).DiscussionIn this article, we presented a 16 week follow-up of aripiprazole treatment in a 23- month-old boy diagnosed with ASD and having symptoms such as intense irritability and hyperactivity. These behavioral issues can result in functional impairment; therefore, behavioral interventions are typically prescribed. …