Atypical antipsychotics in children with pervasive developmental disorders.

The treatment of pervasive developmental disorders (PDDs) is a challenging task, which should include behavioral therapy modifications as well as pharmacologic therapy. There has been a lack of data on using medications in children with PDDs until recent years. Within the last 10 years, an increase in clinical research has attempted to provide efficacy and safety data to support the use of medications in children with PDDs. Double-blinded and open-label research of atypical antipsychotics has been of particular focus. Evidence shows that atypical antipsychotics (AAs) may be useful in treating certain symptoms associated with PDDs, such as aggression, irritability, and self-injurious behavior. This article reviews the literature regarding the use of AAs in children with PDDs. Of the AAs, risperidone has the largest amount of evidence with five published double-blinded, placebo-controlled trials and nine open-label trials. These risperidone trials have consistently shown improvements in aggression, irritability, self-injurious behavior, temper tantrums, and quickly changing moods associated with autistic disorder and other PDDs. Data for the other AAs are limited, but ziprasidone and aripiprazole appear to be promising treatment options. Based on clinical trials, olanzapine and quetiapine have shown minimal clinical benefit and a high incidence of weight gain and sedation. It should be noted that all AAs do have a risk of metabolic syndrome, and patients should be monitored appropriately while receiving these medications. Overall, AAs can be beneficial in alleviating behavioral symptoms, and should be considered an appropriate therapeutic option, as part of a comprehensive treatment strategy, for children with PDD.

Toma de perspectiva y teoría de la mente: aspectos conceptuales y empíricos. Una propuesta complementaria y pragmática

resumen está disponible en el texto completo

Abstract: The present work completes an exhaustive revisión of the delimitation of the ability of perspective taking from different points of view. First, perspective taking is defined as the ability of an individual to interpret his/hers emotional and mental states and those of others. Additionally, the term has also been used in medical settings to refer to a tactic intended to stop certain limiting feeling and/or thoughts and instead move feelings and thoughts towards a different direction. At the same time, perspective taking is considered to be at the heart of psychological phenomena such as empathy, that is, the capacity to distinguish what individuals know about themselves in a certain situation (how someone thinks, feels and behaves), self-awareness, interpersonal relations, and various social skills deficits. Second, this ability is conceptualized as a metacognition and it is assumed that the object of study is the theory of the mind. Third, from a developmental perspective, data have shown that children four to five years old, without any psychological disabilities, have the ability to take somebody else's perspective. We reviewed different studies regarding the development of the abilities to express and interpret emotions as precursors to perspective taking. Subsequently, we revised and analyzed the tests or strategies most commonly used to evaluate the ability of perspective taking. Typically, the capacity of an individual to have "a theory of the mind" is determined through tests of false beliefs (such as the classic test of Sally-Anne, the "Smarties" test, "M&M's", and the "Maxi's" Test). Múltiple variations of the tests of false beliefs have been conducted with flashcards or photographs, with characters in oral stories, and through the use of games. Additionally, over the last few years the focus of this body of research has evolved towards the elaboration and validation instruments to measure empathy. Among them are the tests of Empathy Quotient (EQ), the Friendship Questionnaire (FQ), and reading the "mind" in the eyes. It is important to note that these efforts have been focused mostly on individuals with Asperger" s Syndrome or those with higher verbal capabilities. From this latter perspective, we propose empirical evidence that points out to differences in the ability of perspective taking between children with or without autism. This is also shown in the results of previous studies, in which different levels of perspective taking skills were seen between children diagnosed with autism, and those diagnosed with Down Syndrome. It is important to note that this was not true when their verbal skills were not considered as a variable. Likewise, other studies showed that children with autism were not the only ones that failed the theory of the mind tests, but that these tests were also failed by those children with deficits in language and cognitive skills. In this article, we present the results of a study that replicates previous findings which show that typical developing children per-form better in perspective taking tests, followed by children diag-nosed with Down Syndrome, and subsequently by children with autism. It was also noted that the typical developing children showed the highest level of verbal discrimination, followed by the children diagnosed with Down Syndrome, and finally the children diagnosed with autism. One important finding in this study is that all children benefited from the use of contextual prompts, which improved the number of correct responses across all the theory of the mind tests. Additionally, the data varied depending on the type of tests utilized to measure perspective taking skills. In this article, we have also reviewed the different explanations for the origins and development of perspective taking, among which the theory of the mind prevails. The ability to take some-one else's perspective is explained by the development or matura-tion of an innate and specialized module of representations and knowledge, and the formation of conceptual structures of a higher order or meta-representations. Additionally, the ability to ignore perceptual information, salient or not, and to combine simultaneously various contexts are considered prerequisites. In other words, perspective taking speaks to the relationship between psychological constructs such as perception and knowledge. Additionally, it has been hypothesized that shared, joint, or independent attention can be a prerequisite for conversation, and may be the basis of a theory of the mind. In any case, the origins of the development of such a theory have been especially ubiquitous in terms of the executive function and possible relations with cerebral lesions or alterations. However, some authors consider that the process of central coherence may be relatively independent of a theory of the mind. The research of Baron-Cohen et al. has concentrated on identifying existing neurological deficits or organic changes such as bilateral lesions or the role of testosterone on the quality of social interactions and the restrictive social interests of individuals with autism. A similar interest exists in researching the difference in perspective taking and empathy abilities exhibited by members of the opposite sex. Continuing with the neurological foundations of the empathy is of full present time the discoveries regarding «mirror neurons¼ and this recent study with monkeys proposes a specific cerebral area for the formation of the meta-representation. These neurons discharge both when the individual performs an action and when the individual observes another person performing the same action. Finally, even in the light of all the above, other sources point toward the social root of perspective taking skills. Additionally, as indicated by the research of Howlin, Baron-Cohen & Hadwin, it is considered perspective taking includes five different levels: a) simple visual perspective taking, b) the knowl-edge that different individuals can have separately the same thoughts, and c) understanding that "seeing leads to learning," followed by d) the ability to predict actions based on valid beliefs, and finally e) the ability to predict false beliefs. In the light of all of the above, once the radical conclusions of these investigations are viewed critically, the theory of the mind is viewed as a disputable theory of the delimitation of the cause and development of such skills. In addition, to the perspective taking tests themselves, the pre-requisite skills of perspective taking need to be extensively ana-lyzed. In fact, it has been shown that, in order to have an adequate performance on these tests of false beliefs, individuals should be able: 1. to remember and adequately retell their own past desires, thoughts, and past actions; 2. to retain an object in their mind, perceive a second object, and form a relationship between the two, as in a "symbolic function"; 3. to demonstrate the ability to pretend; and 4. to identify the role of age and verbal abilities in children as pre-requisites for an accurate performance on tests of false beliefs, and interpretations of the world. Lastly, we propose a pragmatic and complementary analysis the Theory of Mind based in the functional-contextual analysis of behavior. First, it is considered that perspective taking requires or is closely related to other social behaviors (such as taking turns when talking, initiating verbal responses in interpersonal relations, and the capacity for empathy). In the same manner, theory of mind requires an adequate level of simple and complex conditional discriminations, and these should be analyzed in terms of stimulus control and equivalence relations. In other words, this ability to infer thoughts, feeling, and emotions of others exists if the following prerequisites are present: 1. the processes of the classical conditioning of the emotions, 2. a generalized imitation, and 3. the development of functional classes. Without these experiences or the capability to be affected by them, children (i.e. children with generalized autism) do not develop language adequately. Second, perspective taking implies that an observer's previous experiences and observations with certain events determine his/ her reaction to responses emitted by others in similar circumstances. Finally, from a contextual perspective, it is considered that a speaker's relational frames play a role in this process (for the discriminations I/you, here/there, now/later). These relational properties are abstracted through multiple exemplars or multiple learning opportunities to speak from one's own perspective in relation to others.

Role of risperidone in children with autism spectrum disorder.

OBJECTIVE: To review the clinical trials investigating the efficacy and safety of risperidone in the treatment of children with autism spectrum disorder (ASD). DATA SOURCES: Searches of MEDLINE/PubMed (1992-February 2006) were conducted, as well as an extensive manual review of journals, using the key words autism and risperidone. STUDY SELECTION AND DATA EXTRACTION: Only double-blind, placebo-controlled trials were included for review. DATA SYNTHESIS: ASD is the most common of the pervasive developmental disorders. The main characteristics (core symptoms) of autism are impairment in social skills, problems communicating, and stereotypical movements. Behavioral manifestations or maladaptive behaviors include aggression, irritability, hyperactivity, inattention, impulsivity, tantrums, and self-injurious behavior. CONCLUSIONS: Based on the data examined, risperidone appears efficacious and safe for treating certain behavioral aspects of autism including irritability, aggression, hyperactivity, and stereotypy. It does not appear to be as effective for the treatment of the core symptoms of autism.

The emergence of the listener to speaker component of naming in children as a function of multiple exemplar instruction.

We tested the effect of multiple exemplar instruction on the transfer of stimulus function for unfamiliar pictures across listener responses (i.e., matching and pointing) and speaker responses (i.e., pure tacts and impure tacts). Three preschool students, who were 3- and 4-year-old males and did not have the listener to speaker component of the naming repertoire, participated in the experiment. The dependent variable was numbers of correct responses to probe trials of both untaught listener responses ("point to__") and speaker responses (tact and impure tacts) following mastery of matching responses for two sets of five unfamiliar pictures (Set 1 and Set 3). After each participant mastered matching (e.g., "match Labrador") for Set 1 pictures they were probed on the three untaught responses to Set 1 words. That is, they were asked to point to Labrador, tact the picture of Labrador, and respond to the picture of a Labrador and the question "What is this?" Next, the participants were taught mastery of all four types of responses using MEI for a second set of five pictures (Set 2) and probed again on the 3 untaught Set 1 responses. Finally, matching responses were taught to mastery for a novel set of pictures (Set 3) and then probed on the three untaught responses. The results showed that untaught speaker responses emerged at 60% to 85% for two participants, and 40%-70% for one participant. We discuss the role of instructional history in the development of the listener to speaker component of naming.