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Biomedical subjects

M G Aman

Publications and source records attributed to M G Aman.

At least 19 recordsLinked to original sources
PubMed1997

The international consensus process on psychopharmacology and intellectual disability.

The present authors invited 115 scientists, practitioners and consumers from 11 nations to form an international consensus panel on best practices and clinical effects regarding psychoactive medicines and intellectual disability. Co-sponsors included the American Association on Mental Retardation, the American Psychiatric Association, the American Psychological Association, the National Institute of Mental Health, the National Association on Dual Diagnosis and The Arc of the United States. The panel developed 21 reports that were revised to reflect comments from 351 participants at a 1995 Ohio State University conference in Columbus, OH, USA. The reports will be published as chapters in a forthcoming book entitled Psychotropic Medication and Developmental Disabilities: The International Consensus Handbook. The need for research and training programmes is discussed.

Diagnostic Errors↗
PubMed1997

Fenfluramine and methylphenidate in children with mental retardation and borderline IQ: clinical effects.

A double-blind, placebo-controlled, crossover study of methylphenidate (0.4 mg/kgday) and different doses of fenfluramine (1.0, 1.5, or 2.0 mg/g/day) in children with mental retardation or borderline IQ and ADHD was conducted. Parents, teachers, examiners, and physicians rated the children. There were relatively few significant drug effects by condition. When the optimal fenfluramine dose for each child was compared with placebo and methylphenidate, significant improvements occurred for fenfluramine on several parent and teacher subscales; teachers rated the children as somewhat improved with methylphenidate. The highest dose of fenfluramine produced more behavior compliance but apparently at the cost of cognitive efficiency. Most side effects (drowsiness, dizziness, anorexia) occurred with fenfluramine. Both drugs appear to be effective treatments for children with ADHD and mental retardation, although there is a possible neurotoxic action with fenfluramine. We recommend a gradual phase-in of fenfluramine dosage, up to 1.5 mg/kg/day, for most children.

Adolescent↗
PubMed1995

Consumer satisfaction with involvement in drug research: a social validity study.

OBJECTIVE: To assess the social importance and personal benefit attached to involvement in drug research for participating families. METHOD: Parents of children with mental retardation or borderline IQ who took part in two drug studies were surveyed by mail 4 weeks after their involvement. The questionnaire addressed the acceptability of study procedures and satisfaction with study outcomes ("social validity"). RESULTS: Forty (63.5%) of 63 families responded to the survey. In all, 83% felt that their questions were satisfactorily answered regarding the role of medication for their children, and 88% were satisfied with the individual conclusions reached regarding pharmacotherapy for their children. Virtually all parents believed that the study assessments used were important, and 88% indicated that they would join the study again if faced with the same choices. CONCLUSIONS: These parents appear to have found the research experience to be of practical benefit to them, and they were generally positive about their experiences. As this seems to be the only published study of the social or perceived validity of drug research, more surveys of this type are needed to assess consumer reactions to a broader array of research experiences.

Adolescent↗
PubMed1995

Psychotropic and anticonvulsant drugs in subjects with autism: prevalence and patterns of use.

OBJECTIVE: To survey the prevalence and patterns of psychotropic and anticonvulsant medication and vitamin treatments in patients with autism. METHOD: Caregivers of 1,595 index cases were sent survey questionnaires by mail, and repeat questionnaires were sent twice if no reply was received. RESULTS: A total of 838 care providers (53%) responded to the survey. In all, 33.8% of the sample was taking some psychotropic drug or vitamin for autism or associated behavioral/psychiatric problems. A total of 19.2% reported having epilepsy, but only 13.2% were taking anticonvulsant drugs. More than 50% of the sample was taking some psychotropic, antiepileptic, vitamin, or "medical" agent. Of the agents taken, care providers were most satisfied with anticonvulsants, antidepressants, and stimulants. The use of each drug group was analyzed with respect to subject and demographic variables to evaluate medication patterns within this population. CONCLUSION: As in the often related clinical population of mental retardation, psychotropic medication appears to be heavily used in patients with autism.

Adolescent↗
PubMed1995

Psychotropic drugs in group homes: prevalence and relation to demographic/psychiatric variables.

All 1,101 clients residing in over 120 group homes of a residential services agency were surveyed on one date for presence of psychotropic medication. In all, 27% received one or more psychotropic drugs for behavioral or emotional disorders. Disorders and target behaviors listed for each drug group were examined and the relations between drug groups and diagnostic/demographic variables analyzed. In addition, logistic regression analyses were used to examine subject variable/drug relations further and the likelihood of receiving a specific class of medication given the presence of a subject variable. Certain physical and sensory handicaps were associated with less medication use. Generally speaking, the existence of DSM diagnoses (especially psychosis and mood disorder) and certain target behaviors were associated with greater medication use. In the main, medication use was consistent with known or presumptive indications for the respective drug groups, although unestablished applications were also observed.

Adolescent↗
PubMed1995

The Aberrant Behavior Checklist-Community: factor validity and effect of subject variables for adults in group homes.

The factor validity of the new Aberrant Behavior Checklist-Community (ABC-C) was determined with 1,040 group home residents. Exploratory factor analysis indicated that the factor structure derived from the original ABC appears to be valid for the ABC-C when used with this population. Coefficients of congruence showed a high level of concordance with the original factor structure, and internal consistency continued to be high for each of the five subscales. Analyses for the effects of age, gender, and level of mental retardation indicated that some correction is appropriate for each of these variables when scoring the ABC-C. Further analyses explored the effects of subjects variables such as visual and auditory handicaps and the presence of epilepsy or Down syndrome. Psychotropic medication use was often associated with subscale score differences. The original ABC factor structure appears valid for scoring the ABC-C with community-based adults, at least those living in group homes.

Adolescent↗
PubMed1994

Ratings of hyperactivity and developmental indices: should clinicians correct for developmental level?

This study assessed the relationship between parent and teacher ratings of hyperactivity and developmental indices (chronological age, IQ, and mental age) in two groups of children. Subjects were drawn separately from two psychiatric clinics: (a) a general clinical sample, largely of normal ability, seen for a multitude of psychiatric and behavioral problems, and (b) a developmental clinic sample, comprising children with cognitive delays and seen for ADHD or the absence of ADHD. The results showed consistent negative correlations between chronological age and severity of hyperactivity symptoms; however, these occurred mainly within the developmental clinic sample. Only 4 of 27 comparisons (15%) between mental age and hyperactivity ratings (all confined to the developmentally delayed sample) showed a significant correlation. When chronological age was first partialled out, the correlations between ratings of hyperactivity and mental age ceased to be significant. Findings suggest that chronological age should be taken into consideration when behavior ratings are used to assess cognitively delayed children for ADHD. However, the results do not support guidelines stating that mental age must be used to determine which norms should be applied when such children are evaluated clinically.

Adolescent↗
PubMed1993

Fenfluramine and methylphenidate in children with mental retardation and attention deficit hyperactivity disorder: laboratory effects.

Twenty-eight children took part in a double-blind, placebo-controlled, crossover study of fenfluramine and methylphenidate. Fenfluramine dosage was gradually increased to a standardized dose of 1.5 mg/kg per day, whereas methylphenidate was given in doses of 0.4 mg/kg per day. The children were assessed on laboratory tests of selective and sustained attention, visual matching, and color matching, during which seat activity was monitored automatically. Results showed fenfluramine to be superior to placebo on the memory task, whereas methylphenidate reduced commission errors on a continuous performance test. Methylphenidate caused shorter response times, and fenfluramine caused increases, on two of the tests. Examiner behavior ratings indicated significant improvements with both drugs on the domains of attention, activity level, and mood. These findings, together with those from a companion clinical study, suggest that the drugs may have contrasting mechanisms of action, but both appear to have useful clinical effects in these children.

Adolescent↗
PubMed1993

Fenfluramine and methylphenidate in children with mental retardation and ADHD: clinical and side effects.

Each of 28 nonautistic children with attention-deficit hyperactivity disorder and mental retardation received placebo, methylphenidate (0.4 mg/kg/day), and fenfluramine (gradually increased to 1.5 mg/kg/day) for 4 weeks each in a double-blind, crossover design. Teacher ratings indicated significant improvements with both active drugs on subscales designated as Conduct Problem, Hyperactivity, and Irritability, but methylphenidate alone produced improvements on an Inattention subscale. Parent ratings indicated significant improvements with both drugs on subscales labeled Hyperactivity, Motor Excess, and Conduct Problem. Fenfluramine alone caused improved parent ratings on Irritability and Inappropriate Speech, and on Conners' Abbreviated Symptom Questionnaire. Unlike a previous study, subgroup analyses failed to show a significantly better clinical response to methylphenidate for subjects with higher mental ages, although children with higher IQs responded better than those with IQs less than 45. The active drugs had contrasting effects on heart rate and blood pressure. Fenfluramine caused significant weight reductions relative to both placebo and methylphenidate. These findings suggest that both methylphenidate and fenfluramine have useful, but somewhat different, clinical effects in certain children with attention-deficit hyperactivity disorder and mental retardation.

Adolescent↗
PubMed1993

Efficacy of psychotropic drugs for reducing self-injurious behavior in the developmental disabilities.

Self-injurious behavior (SIB) is a serious and moderately prevalent problem behavior among developmentally disabled persons, and it frequently leads to treatment with psychotropic medication. The empirical literature relating to the efficacy of pharmacological intervention is comprehensively reviewed. The rationales for using some "newer" agents, such as serotonin reuptake blockers, opiate blockers, and beta-adrenergic blockers are described. In general there are insufficient data to draw conclusions about specific agents. Evidence for a possible role in managing SIB is strongest for thioridazine, lithium carbonate, and the opiate antagonists. However, further research is needed to define the specific indications, if any, for each of these. Impediments to past research are discussed, possible refinements are offered for future research, and recommendations for treatment are offered.

Adrenergic beta-Antagonists↗
PubMed1993

Biological and environmental risk for poor developmental outcome of young children.

A cross-sectional retrospective study was conducted to develop and field test a state-wide screening method for identifying children at risk for developmental problems. Families of 2.5- to 3-year-old children were sampled from the Ohio birth certificate register. Standardized telephone interviews were conducted with 1,601 parents concerning home environment and demographic characteristics. Developmental delay, the outcome variable, was defined by low scores on an abbreviated Developmental Profile II, which was also administered over the telephone. Obstetric history and health status of the newborns was obtained from birth certificates. By means of logistic regression analysis, we found six independent variables representing environmental and biological determinants.

Child Development↗
PubMed1992

Factor validity and norms for the aberrant behavior checklist in a community sample of children with mental retardation.

The Aberrant Behavior Checklist (ABC) is a 58-item rating scale that was developed primarily to measure the effects of pharmacological intervention in individuals living in residential facilities. This study investigated the use of the ABC in a sample of community children with mental retardation. Teacher ratings on the ABC were collected on 666 students attending special classes. The data were factor analyzed and compared with other studies using the ABC. In addition, subscales were analyzed as a function of age, sex, and classroom placement, and preliminary norms were derived. A four-factor solution of the ABC was obtained. Congruence between the four derived factors and corresponding factors from the original ABC was high (congruence coefficients ranged between .87 and .96). Classroom placement and age had significant effects on subscale scores, whereas sex failed to affect ratings. The current results are sufficiently close to the original factor solution that the original scoring method can be used with community samples, although further studies are needed to look at this in more detail.

Adolescent↗
PubMed1992

Behavior of children with seizures. Comparison with norms and effect of seizure type.

Scores for 112 children aged 6 to 12 years, with well-controlled seizures and of average or higher IQ, were compared for problem behavior with established norms. As assessed on the Conners' Teacher Rating Scale, the group with seizures was comparable to the normative group on two subscales and superior on two others. In contrast, parents of children in the seizure group rated them as significantly worse on all six subscales of the Revised Behavior Problem Checklist. In a larger group of 133 children with seizures, from which this sample was selected, the relationship of age, sex, and seizure type to behavior problems was examined. Subjects with partial seizures were rated as slightly more aggressive and antisocial than those with generalized seizures. Findings were discussed in regard to differences in perception of behavior by parents and teachers and the possible relevance of seizure type to the expression of behavior problems.

Adolescent↗
PubMed1991

Prediction of clinical response in children taking methylphenidate.

Twenty-six children having Attention Deficit Hyperactivity Disorder were tested before and after treatment with methylphenidate. In addition to standardized parent and teacher rating scales, each child was assessed on a variety of psychomotor tests with an emphasis on attentional constructs. Relatively few of the performance tests, administered prior to medication, predicted clinical response to medication. However, chronological age and performance on a memory distraction task and on the Graduated Holes Task (Kløve, 1963) were moderately correlated with clinical outcome. Using stepwise multiple regression analyses to predict outcome, age and the psychomotor tasks predicted about 50% of outcome variance. There was virtually no relationship between clinical change and change on the performance tests. Findings are discussed with respect to results from previous prediction studies, theoretical models of drug response, and clinical management.

Attention↗
PubMed1991

Clinical effects of methylphenidate and thioridazine in intellectually subaverage children.

Thirty children with subaverage IQs and psychiatric diagnoses of attention deficit disorder and/or or conduct disorder took part in a double-blind study of placebo, methylphenidate, and thioridazine, which were given for 3 weeks each. The results showed a consistent and highly significant effect of methylphenidate in reducing teacher ratings of problem behavior. Parent ratings showed no behavioral effects for the group as a whole. An attentional model of stimulant drug response was used to divide subjects according to a cognitive maturity domain presumed to reflect selective attention. When divided according to breadth of attention, mental age, and IQ level, higher functioning subjects were found to show a generally favorable response to methylphenidate on both teacher and parent rating scales, whereas children of low functional level typically showed an adverse or indifferent response. The present data suggest that mental age and IQ may be important determinants of drug response; below a given level, there was a greatly reduced likelihood of responding positively. Clinical response to thioridazine was substantially less than the response to methylphenidate, with significant improvements confined to conduct and hyperactivity problems on teacher ratings.

Adolescent↗
PubMed1991

Methylphenidate and thioridazine in the treatment of intellectually subaverage children: effects on cognitive-motor performance.

Twenty-seven children (or smaller subgroups depending upon task difficulty and subject ability) with subaverage IQs took part in a double-blind, placebo-controlled, cross-over study of methylphenidate (0.4 mg/kg/day) and thioridazine (1.75 mg/kg/day). The children were tested for IQ performance, breadth of attention, and performance on a series of electronically controlled cognitive-motor tests. Methylphenidate improved accuracy on a memory task, reduced omission errors on an attentional task, and reduced seat movements on two tasks. Thioridazine failed to have any deleterious effects on IQ performance when subjects received reinforcers for correct answers. Thioridazine at the given dose did not adversely affect performance on any of the cognitive-motor performance tests. Methylphenidate appears likely to enhance sustained attention and motivation in appropriately selected children with mild developmental delays, whereas thioridazine at this modest dose does not appear to impair performance on most psychomotor tests.

Adolescent↗