N-acetylcysteine as treatment for self-injurious behavior in a child with autism.

摘要: [Author Affiliation]Sarah Marler. Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee.Kevin B. Sanders. Tennessee.Jeremy Veenstra-VanderWeele. Tennessee.Address correspondence to: Jeremy Veenstra-VanderWeele, MD, Associate Professor Pediatrics, Pharmacology, Kennedy Center for Research on Human Development, Brain Institute, 7158 Building III, 465 21st Ave. S. TN 37232, E-mail: j.vvw@vanderbilt.eduTo The Editor:Self-injurious behaviors (SIB), including skin picking/scratching, self-biting, head banging have been reported to occur in as many 50% children with autism spectrum disorders (ASD) (Rojahn 1994; Richards et al. 2012). More than 14% reportedly exhibit "severe" SIB, which indicates that the behavior results functional impairment or life-threatening injury (Baghdadli 2003; Duerden An inverse relationship exists between presence SIB severity intellectual (Berkson 1983; Rojahn Esbensen 2002; Symons 2005; Hillery Dodd 2007), frequently co-occurs syndromes often associated intellectual/developmental disabilities, such Lesch-Nyhan syndrome (Nyhan Wong 1996), Rett (Deb 1998), Prader-Willi (Dykens Kasari 1997), Fragile X (Symons 2003). Numerous hypotheses regarding etiology emerged over years, (but not limited to) a symptom physical discomfort/organic illness, result neurochemical imbalance, learned behavior, form communication, self-stimulation (Rana 2013).SIB is approached treated discrete independent from other maladaptive (Bodfish Lewis 2002); however, self-injury ASD generally impairing symptoms, high levels impulsivity, irritability, stereotypies, paired lower functioning (Matson 2008; Richman 2013). are commonly targeted treatment by means pharmacology (Soorya 2008), communication strategies (Johnson Rodriguez 2013), behavioral modification (Minshawi 2008 Devlin 2011). To date, no single intervention strategy has consistently effective (King 2000; Lang 2010; Oliver 2010).Limited data support use any medication class specifically whether developmental disabilities Rana A number medications sometimes used try address self-injury, serotonin reuptake inhibitors (SRIs), atypical antipsychotics, α agonists, opioid antagonists. most overall individuals SRIs (Aman 2005), although these shown ambiguous efficacy (McDougle al King 2009; Williams well pathological picking (Simeon 1997; Bloch 2001; Arbabi 2008). Atypical antipsychotics second pharmacological 2005). Although compulsive disruptive demonstrated large-scale, randomized controlled trials (RCTs), little evidence specific benefit (McCracken Shea 2004; McDougle Marcus Owen 2009). also reducing adults disability, without (Ruedrich …