Lack of Effect of Risperidone on Core Autistic Symptoms: Data from a Longitudinal Study

Abstract

Objective: The purpose of this study was to investigate the course of autistic symptoms, using a quantitative measure of core autistic traits, among risperidone-treated children who participated in a 10 year life course longitudinal study. Methods: Parents completed surveys of intervention history, as well as serial symptom severity measurements using the Social Responsiveness Scale (SRS), on their autism spectrum disorder (ASD)-affected children. Fifty participants (out of a total of 184 with full intervention histories) were reported to have been treated with risperidone during the course of the study. Serial SRS scores during risperidone treatment were available for a majority of children whose parents reported a positive effect from risperidone. Results: Two thirds of risperidone-treated children (n = 33) were reported by parents to have improved by taking the medication, with the principal effects described being that children were calmer, better focused, and less aggressive. SRS scores of children reported to have responded positively to risperidone did not improve over time. Conclusions: Risperidone's beneficial effect on aggression and other elements of adaptive functioning were not necessarily accompanied by reduction in core ASD symptoms, as serially assessed by the same caregivers who reported improvement in their children. These results reflect the distinction between reduction in core symptom burden and improvement in adaptive functioning. Given the cumulative risks of atypical neuroleptics, the findings underscore the importance of periodic reevaluation of medication benefit for children with ASD receiving neuroleptic treatment.

Autism‐Related Variation in Reciprocal Social Behavior: A Longitudinal Study

“…Second, due to the cohort‐sequential design, no individual was studied from early childhood to adulthood. Third, the affected subjects were receiving a variety of forms of therapy, and although their trajectories could have been influenced by the interventions, their SRS scores still remained stable (see also Marrus, Underwood‐Riordan, Randall, Zhang, & Constantino, ). Finally, this prospective longitudinal study lacked statistical power to fully define specific trajectories of subgroups of subjects.…”

Can Bayesian Theories of Autism Spectrum Disorder Help Improve Clinical Practice?

“…The use of the approved dopamine receptor antagonist (risperidone) is of questionable benefit for cognition in ASD, as its antagonistic effects at dopamine receptors may interfere with precision-weighting of prediction errors, and thus updating of priors, in high-level regions of the cognitive hierarchy such as prefrontal cortex ( 91 ), which are critical for the development of abstract representations. Indeed, empirical studies demonstrate that core symptoms of ASD do not benefit from this medication ( 147 ). Perhaps not surprisingly, this purely symptomatic approach is rarely subjectively experienced as helpful by patients.…”

Validating the social responsiveness scale for adults with autism

“…Duku et al [] investigated measurement invariance of the factor structure of the SRS and found that the factors of the SRS were stable across occasions. Marrus et al [] conducted a 10‐year longitudinal study of risperidone use in children with ASD and found that the SRS was sensitive to detecting change over time. Hasegawa et al [] demonstrated that an increase in parental empathy level was associated with an improvement of autism symptoms as measured by SRS.…”