Citation

Sabus A, Feinstein J, Romani PW, Goldson E, Blackmer A. Pharmacotherapy 2019; 39(6): 645-664.

Affiliation

Special Care Clinic, Children's Hospital Colorado, Aurora, CO.

Copyright

(Copyright © 2019, Pharmacotherapy Publications)

DOI

10.1002/phar.2238

PMID

30793794

Abstract

Neurodevelopmental disorders (NDDs), a group of disorders affecting approximately 1% to 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 are common in children with NDDs; depending on the specific NDDs, the incidence of self-injurious behaviors is nearly 100%. The management of self-injurious behaviors in this population is complex, and little high-quality data exist to guide a consistent approach to therapy. However, managing self-injurious behaviors 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 NDDs 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 self-injurious behaviors in children with NDDs. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

Self-injurious behaviors; children; neurodevelopmental disorders; pediatrics; pharmacotherapy