Case study: The combined use of imipramine and behavior modification to reduce aggression in an adult male diagnosed as having autistic disorder

Abstract

The present study examined the behavior decelerative effects of combined imipramine (tofranil) and behavior modification in a severely retarded, depressed autistic man. A simple interrupted time-series design was conducted and the primary data analytic techniques consisted of modified trend analyses and dependent samples t-tests. Consistent with previous theory and scant empirical research, results indicated that combined imipramine and behavior modification significantly reduced daily episodes of self-directed and other-directed aggression. Specifically, controlling for the effects of time, the combined treatment regimen led to significant reductions in both level and slope across three topographies of aggressive behavior. Limitations of the present study and recommendations for future research were discussed. It was concluded that combined imipramine and behavior modification may be an effective strategy for reducing aggression in the developmentally disabled.

Treating aggression in persons with autism spectrum disorders: A review

“…Thus, the range of participant numbers across studies varied from one to 218. Thirteen of the papers reported on the treatment of one or two individuals (Braithwaite & Richdale, 2000;Davis et al, 2013;Falcomata, Roane, Muething, Stephenson, & Ing, 2012;Fisher, Lindauer, Alterson, & Thompson, 1998;Foxx & Garito, 2007;Foxx & Meindl, 2007;Hittner, 1994;Kern, Carberry, & Haidara, 1997;Kuhn, Hardesty, & Sweeney, 2009;Luiselli, Blew, Keane, Thibadeau, & Holzman, 2000;Matson, LoVullo, Boisjoli, & Gonzales, 2008;Robertson, Wehby, & King, 2013;Sigafoos & Meikle, 1996), and two studies involved 100 or more people Silverman et al, 2014). The higher number of participated studies involved drug treatments (Arnold et al, 2003;Hellings et al, 2005;King & Davanzo, 1996;Marcus et al, 2009;McDougle et al, 1996;McDougle, Kem, & Posey, 2002;McDougle et al, 1998;Owen et al, 2009;Silverman et al, 2014;Troost et al, 2005), while the low number studies were largely psychologically based interventions.…”

“…Of the 27 papers reviewed, only five studies focused on adults (Hittner, 1994;King & Davanzo, 1996;Lundqvist, Andersson, & Viding, 2009;McDougle et al, 1996McDougle et al, , 1998. As pointed out in reviews on related topics, the bulk of a persons' life is spent as an adults.…”

“…Sixteen of the reviewed studies used psychologically based therapies; one paper employed music (Lundqvist et al, 2009) while the other 15 papers relied on ABA principles and procedures (Braithwaite & Richdale, 2000;Davis et al, 2013;Falcomata et al, 2012;Fisher et al, 1998;Foxx & Garito, 2007;Foxx & Meindl, 2007;Fulton, Eapen, Walter, & Rogers, 2014;Hanley, Jin, Vanselow, & Hanratty, 2014;Hittner, 1994;Kern et al, 1997;Kuhn et al, 2009;Matson, LoVullo, et al, 2008;Robertson et al, 2013;Silverman et al, 2014;Sigafoos & Meikle, 1996). Two papers that used punishment procedures (i.e., overcorrection, physical restraint) were papers by Foxx and colleagues (Foxx & Garito, 2007;Foxx & Meindl, 2007).…”

Treatment of Aggression in Adults with Autism Spectrum Disorder: A Review

“…Table 2 summarizes the 17 N of 1 trials 56 , 57 , 85 – 99 that were reviewed regarding treatments for aggression in adults with ASD. These trials—primarily nonrandomized and crossover in nature—suggest potential usefulness of propranolol, 89 behavioral interventions (such as DRO schedules, 88 , 91 , 92 , 94 positive behavioral support programs, 56 , 57 nonexclusionary time-out procedures, 86 behavioral report cards, 87 use of “do” versus “don’t” requests to interrupt aggressive behavior, 95 provision of social comments prior to task demands, 93 task analysis/forward-chaining with prompt stimulus fading, 99 and electromyographic [EMG] response discrimination biofeedback training 85 ), multisensory environments, 96 and physical exercise. 90 …”

“…Finally, 10 of the 17 studies 56 , 57 , 85 – 88 , 90 , 91 , 93 , 98 were judged to be at serious risk of bias due to baseline or time-varying confounding (i.e., at least one known important confounding domain was not measured or controlled for), while the remaining 7 studies 89 , 92 , 94 – 97 , 99 were assessed to be at moderate risk of bias in this regard (i.e., confounding was expected, but all known important confounding domains were appropriately measured and controlled for). Overall, the nonrandomized nature of most of these studies makes it difficult to firmly conclude that the interventions studied were responsible for the effects observed and to exclude other factors that could have accounted for the outcomes.…”