Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1860-e1866 (doi:10.1542/peds.2005-3101)

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ARTICLE

Pervasive Developmental Disorder, Behavior Problems, and Psychotropic Drug Use in Children and Adolescents With Mental Retardation

Annelies de Bildt, PhD^a, Erik J. Mulder, MD, PhD^a, Tom Scheers, MD^a, Ruud B. Minderaa, MD, PhD^a, Hilde Tobi, PhD^b,c

^a University Medical Center Groningen/Accare University Center for Child and Adolescent Psychiatry, Groningen, the Netherlands
^b Department of Social Pharmacy, Pharmacoepidemiology, and Pharmacotherapy, Groningen University Institute of Drug Exploration, Groningen, the Netherlands
^c Research Methodology Group, Social Sciences Wageningen University Research, Wageningen, the Netherlands

OBJECTIVE. This study investigated the interrelationship between psychopharmacotherapy in general and the use of specific psychotropic drugs and pervasive developmental disorder and other behavior problems in children and adolescents with mental retardation.

METHODS. A total of 862 participants 4 to 18 years of age, including all levels of mental retardation, were recruited through facilities for children with mental retardation in Friesland, the Netherlands. Information on medication was collected through parent interviews. Behavior problems were investigated with a standardized parent questionnaire (Developmental Behavior Checklist). A pervasive developmental disorder classification was based on the Pervasive Developmental Disorder in Mental Retardation Scale, completed by psychologists or teachers. Logistic regression analysis was used to investigate the relationship between the use of psychotropic drugs and pervasive developmental disorder and other behavioral problems, in the presence of possible confounders.

RESULTS. One of 10 participants used psychotropic medication. The main factors associated with psychotropic drug use were pervasive developmental disorder and disruptive behavior. The level of functioning was also associated. Self-absorbed behavior was statistically significantly associated with clonidine use and disruptive behavior with stimulant use. Pervasive developmental disorder and communication problems were the main factors associated with the use of antipsychotic drugs. Age also played a role, whereas gender, living situation, and level of mental retardation did not.

CONCLUSIONS. Antipsychotic drugs were associated with pervasive developmental disorder, whereas clonidine and stimulants were associated with self-absorbed and disruptive behavior, respectively. Although clonidine and risperidone are not registered for the problems reported and the other nonstimulants were only sometimes used on-label, their use was associated with specific psychiatric or behavioral problems.

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Key Words: mental retardation • children • adolescents • psychopharmacology • pervasive developmental disorder • behavior problems • psychotropic agents

Abbreviations: MR—mental retardation • PDD—pervasive developmental disorder • DBC—Developmental Behavior Checklist • PDD-MRS—Pervasive Developmental Disorder in Mental Retardation Scale • OR—odds ratio • CI—confidence interval

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Accepted Jun 19, 2006.

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