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Management of Self‐injurious Behaviors in Children with Neurodevelopmental Disorders: A Pharmacotherapy Overview
Author(s) -
Sabus Ashley,
Feinstein James,
Romani Patrick,
Goldson Edward,
Blackmer Allison
Publication year - 2019
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2238
Subject(s) - cornelia de lange syndrome , medicine , rett syndrome , pharmacotherapy , fragile x syndrome , population , neurodevelopmental disorder , psychological intervention , psychiatry , intensive care medicine , pediatrics , autism , biochemistry , chemistry , environmental health , gene
Neurodevelopmental disorders ( NDD s), a group of disorders affecting ~1–2% of the general population, are caused by changes in brain development that result in behavioral and cognitive alterations, sensory and motor changes, and speech and language deficits. Neurodevelopmental disorders encompass a heterogeneous group of disorders including, but not limited to, Smith‐Magenis syndrome, Lesch‐Nyhan disease, cri du chat syndrome, Prader‐Willi syndrome, pervasive developmental disorders, fragile X syndrome, Rett syndrome, Cornelia de Lange syndrome, and Down syndrome. Self‐injurious behaviors (SIBs) are common in children with NDD s; depending on the specific NDD , the incidence of SIBs is nearly 100%. The management of SIBs in this population is complex, and little high‐quality data exist to guide a consistent approach to therapy. However, managing SIBs is of the utmost importance for the child as well as the family and caregivers. Behavior therapies must be implemented as first‐line therapy. If behavioral interventions alone fail, pharmacotherapy becomes an essential part of management plans. The limited available evidence for the use of common pharmacologic agents, such as second‐generation antipsychotics, and less common agents, such as clonidine, n‐acetylcysteine, riluzole, naltrexone, and topical anesthetics, is reviewed. Additional data from well‐designed studies in children with NDD s are needed to gain a better understanding of this common and troublesome problem including efficacy and safety implications associated with pharmacotherapy. Until then, clinicians must rely on the limited available data, clinical expertise, and ongoing systematic monitoring when managing SIBs in children with NDD s.