human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Prospect i ve population -based follow-up study of 120 individuals with autism followed from childhood to adulthood . Methods : Individuals with autism , diagnosed in childhood , were followed prospect ively for a period of 13–22 years and re-evaluated at ages 17–40 years . The instruments used at follow-up were the  DISCO , WAIS-R , WISC-III , Vinel and Adaptive Behavior Scales , psychiatric-medical examination and GAF-scale .  A set of criteria was used for the classification of outcomes , taking into consideration employment , higher education/vocational training , independent living and peer relations . Results : Six of the 120 ( 5 % ) had died at the time of follow-up , and six declined participation . Overall outcome was poor in 78 % of cases . Only four individuals were independent albeit leading fairly isolated lives . Childhood IQ-level was positively correlated with better adult outcome , as was the existence of some communicative phrase speech at age six years . Conclusions : Children with autism as diagnosed in the 1960s , 1970s , and 1980s may have an even worse psychosocial outcome than previously believed Repetitive behaviors are a core symptom domain in autism that has been linked to alterations in the serotonin system . While the selective serotonin-receptive inhibitor fluvoxamine has been shown to be effective in adults with autism , as yet no published placebo controlled trials with these agents document safety and efficacy in children with autism . This study examines the selective serotonin reuptake inhibitor liquid fluoxetine in the treatment of repetitive behaviors in childhood and adolescent autism spectrum disorders ( ASDs ) . In total , 45 child or adolescent patients with ASD were r and omized into two acute 8-week phases in a double-blind placebo-controlled crossover study of liquid fluoxetine . Study design included two r and omized 8-week fluoxetine and placebo phases separated by a 4-week washout phase . Outcome measures included measures of repetitive behaviors and global improvement . Low-dose liquid fluoxetine ( mean final dose : 9.9±4.35 mg/day ) was superior to placebo in the treatment of repetitive behaviors by CY-BOCS compulsion scale . The effect size was in the moderate to large range , and the doses used were low . Liquid fluoxetine was only slightly , and not significantly , superior to placebo on CGI autism score partially due to a phase order effect . However , fluoxetine was marginally superior to placebo on a composite measure of global effectiveness . Liquid fluoxetine did not significantly differ from placebo  on treatment emergent side effects . Liquid fluoxetine in low doses is more effective than placebo in the treatment of repetitive behaviors in childhood autism . Limitations include small sample size and the crossover design of the study . Further replication and long-term maintenance trials are needed The Studies to Advance Autism Research and Treatment Network conducted a r and omized trial with citalopram in children with Pervasive developmental disorders ( PDDs ) . We present the rationale , design and sample characteristics of the citalopram trial . Subjects ( 128 boys , 21 girls ) had a mean age of 9.3 ( ±3.12 ) years ; 132 ( 88.6 % ) were diagnosed with autistic disorder ( 4.7 % with Asperger ’s Disorder ; 6.7 % with PDD-not otherwise specified ) . Less than half of the subjects were intellectually disabled ; 117 ( 78.5 % ) were rated Moderate or Marked on the Clinical Global Impression for Severity . Study measures were similar to previous Research Units on Pediatric Psychopharmacology trials . Subjects in this trial were slightly older and more likely to have complaints of repetitive behavior  than participants in RUPP trials OBJECTIVE . The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use . METHODS . This cross-sectional study used Medicaid cl aims for calendar year 2001 from all 50 states and Washington , DC , to examine 60641 children with an autism spectrum disorder diagnosis .  Logistic regression with r and om effects was used to examine the child , county , and state factors associated with psychotropic medication use . RESULTS . Of the sample , 56 % used at least 1 psychotropic medication , 20 % of whom were prescribed ≥3 medications concurrently . Use was common even in children aged 0 to 2 years ( 18 % ) and 3 to 5 years ( 32 % ) . Neuroleptic drugs were the most common psychotropic class ( 31 % ) , followed by antidepressants ( 25 % ) and stimulants ( 22 % ) . In adjusted analyses , male , older , and white children ; those who were in foster care or in the Medicaid disability category ; those who received additional psychiatric diagnoses ; and those who used more autism spectrum disorder services were more likely to have  used psychotropic drugs  . Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications . CONCLUSIONS . Psychotropic medication use is common among even very young children with autism spectrum disorders . Factors unrelated to clinical presentation seem highly associated with prescribing practice s. Given the limited evidence base , there is an urgent need to assess the risks , benefits , and costs of medication use and underst and the local and national policies that affect medication use We examined the construction of the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and performance of subscale items based on data from 204 patients with obsessive-compulsive disorder ( OCD ) who participated in a multicenter drug treatment study . Factor analysis was used to examine the relationship among the 10 items that make up the Y-BOCS instrument . Models were computed in which both two- and three-factor solutions were estimated . Within the two-factor solution analyses , the factor distribution was not so consistent as in the three-factor solution analyses , and a shift in the factor distribution was noted after treatment . In the three-factor solution analyses , an independent resistance construct emerged in addition to the obsessive and compulsive constructs . Examination of the postreatment factor scores showed that the Y-BOCS resistance items did not assess OCD symptom change as sensitively as the rest of the Y-BOCS items did BACKGROUND Atypical antipsychotic agents , which block postsynaptic dopamine and serotonin receptors , have advantages over traditional antipsychotic medications in the treatment of adults with schizophrenia and may be beneficial in children with autistic disorder who have serious behavioral disturbances . However , data on the safety and efficacy of atypical antipsychotic agents in children are limited . METHODS We conducted a multisite , r and omized , double-blind trial of risperidone as compared with placebo for the treatment of autistic disorder accompanied by severe tantrums , aggression , or self-injurious behavior in children 5 to 17 years old . The primary outcome measures were the score on the Irritability subscale of the Aberrant Behavior Checklist and the rating on the Clinical Global Impressions - Improvement ( CGI-I ) scale at eight weeks . RESULTS A total of 101 children ( 82 boys and 19 girls ; mean [ + /-SD ] age , 8.8+/-2.7 years ) were r and omly assigned to receive risperidone ( 49 children ) or placebo ( 52 ) . Treatment with risperidone for eight weeks ( dose range , 0.5 to 3.5 mg per day ) result ed in a 56.9 percent reduction in the Irritability score , as compared with a 14.1 percent decrease in the placebo group ( P<0.001 ) . The rate of a positive response , defined as at least a 25 percent decrease in the Irritability score and a rating of much improved or very much improved on the CGI-I scale , was 69 percent in the risperidone group ( 34 of 49 children had a positive response ) and 12 percent in the placebo group ( 6 of 52 , P<0.001 ) . Risperidone therapy was associated with an average weight gain of 2.7+/-2.9 kg , as compared with 0.8+/-2.2 kg with placebo ( P<0.001 ) . Increased appetite , fatigue , drowsiness , dizziness , and drooling were more common in the risperidone group than in the placebo group ( P<0.05 for each comparison ) . In two thirds of the children with a positive response to risperidone at eight weeks ( 23 of 34 ) , the benefit was maintained at six months . CONCLUSIONS Risperidone was effective and well tolerated for the treatment of tantrums , aggression , or self-injurious behavior in children with autistic disorder . The short period of this trial limits inferences about adverse effects such as tardive dyskinesia Clomipramine , haloperidol , and placebo were compared with baseline in the treatment of autism , and overall outcome , specific symptoms , and side effects were examined . It was hypothesized that clomipramine would be better tolerated than haloperidol and prove superior on a measure of stereotypy . Individuals with a DSM-IV diagnosis of autistic disorder ( mean age , 16.3 years ; range , 10–36 years ) were r and omly assigned , by using a Latin square design , to the following 7-week trials : placebo , clomipramine ( mean daily dose , 128.4 mg ; range , 100–150 mg ) , or haloperidol ( mean daily dose , 1.3 mg ; range , 1–1.5 mg ) . Data on 36 subjects were analyzed and taken together ; the results favored haloperidol . In those patients who were able to complete a full therapeutic trial , clomipramine proved comparable to haloperidol in terms of improvement compared with baseline . However , significantly fewer individuals receiving clomipramine versus haloperidol were able to complete the trial ( 37.5 % vs. 69.7 % , respectively ) for reasons related to both side effects and efficacy or behavior problems . In the intent-to-treat sample , which is perhaps more clinical ly relevant , only haloperidol proved superior to baseline on a global measure of autistic symptom severity , as well as specific measures for irritability and hyperactivity . Clomipramine did not seem more effective on a measure of stereotypy , nor was it better tolerated The short-term efficacy and tolerability of sertraline for adults with pervasive developmental disorders ( PDDs ) were assessed in this investigation . Forty-two adults with PDDs ( autistic disorder , N = 22 ; Asperger 's disorder , N = 6 ; and PDD not otherwise specified [ NOS ] , N = 14 ) participated in a 12-week , open-label , systematic trial of sertraline .  Behavioral ratings of repetitive symptoms , aggression , and social relatedness were obtained at baseline and after 4 , 8 , and 12 weeks of sertraline administration . Twenty-four ( 57 % ) of 42 patients showed significant improvement , primarily in repetitive and aggressive symptoms . Statistically significant changes in measures of social relatedness did not occur . Patients with autistic disorder and PDD NOS did significantly better than those with Asperger 's disorder . Based on global improvement item criteria from the Clinical Global Impression Scale , 15 of 22 ( 68 % ) patients with autistic disorder , none of six ( 0 % ) patients with Asperger 's disorder , and 9 of 14 ( 64 % ) patients with PDD NOS were categorized as treatment responders . Sertraline was well tolerated ; no adverse cardiovascular effects , extrapyramidal symptoms , or seizures were identified . These findings suggested that sertraline may be an effective treatment for interfering repetitive and aggressive symptoms in adults with PDDs . Definitive statements about the efficacy and tolerability of sertraline for treating adults with PDDs must await results from double-blind , placebo-controlled trials . These preliminary results should not be generalized to include children and adolescents with PDDs BACKGROUND Autistic disorder is characterized by a fundamental disturbance in social interaction , impairments in communication , and a markedly restricted repertoire of activities and interests . Abnormalities in the serotonin neurotransmitter system have been identified in some persons with autism . No consistently effective and safe drugs have been developed for treating the symptoms of autism . METHODS Thirty adults with autistic disorder completed a 12-week double-blind , placebo-controlled trial of the potent and selective serotonin uptake inhibitor fluvoxamine maleate . Behavioral ratings were obtained at baseline and after 4 , 8 , and 12 weeks of treatment . RESULTS Eight ( 53 % ) of 15 patients in the fluvoxamine-treated group were categorized as responders compared with none of 15 in the placebo group ( P = .001 ) . Fluvoxamine was superior to placebo in reducing repetitive thoughts and behavior ( P < .001 ) , maladaptive behavior ( P < .001 ) , and aggression ( P < .03 ) , and in improving some aspects of social relatedness ( P < .04 ) , especially language usage ( P < .008 ) . Treatment response was not correlated with age level of autistic behavior , or full-scale IQ . Other than mild sedation and nausea in a few patients , fluvoxamine was well tolerated . No dyskinesias , adverse cardiovascular events , or seizures occurred . CONCL 
    Output:
    
agent
AUTHORS ' CONCLUSIONS There is no evidence of effect of SSRIs in children and emerging evidence of harm .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Prospect i ve population -based follow-up study of 120 individuals with autism followed from childhood to adulthood . Methods : Individuals with autism , diagnosed in childhood , were followed prospect ively for a period of 13–22 years and re-evaluated at ages 17–40 years . The instruments used at follow-up were the  DISCO , WAIS-R , WISC-III , Vinel and Adaptive Behavior Scales , psychiatric-medical examination and GAF-scale .  A set of criteria was used for the classification of outcomes , taking into consideration employment , higher education/vocational training , independent living and peer relations . Results : Six of the 120 ( 5 % ) had died at the time of follow-up , and six declined participation . Overall outcome was poor in 78 % of cases . Only four individuals were independent albeit leading fairly isolated lives . Childhood IQ-level was positively correlated with better adult outcome , as was the existence of some communicative phrase speech at age six years . Conclusions : Children with autism as diagnosed in the 1960s , 1970s , and 1980s may have an even worse psychosocial outcome than previously believed Repetitive behaviors are a core symptom domain in autism that has been linked to alterations in the serotonin system . While the selective serotonin-receptive inhibitor fluvoxamine has been shown to be effective in adults with autism , as yet no published placebo controlled trials with these agents document safety and efficacy in children with autism . This study examines the selective serotonin reuptake inhibitor liquid fluoxetine in the treatment of repetitive behaviors in childhood and adolescent autism spectrum disorders ( ASDs ) . In total , 45 child or adolescent patients with ASD were r and omized into two acute 8-week phases in a double-blind placebo-controlled crossover study of liquid fluoxetine . Study design included two r and omized 8-week fluoxetine and placebo phases separated by a 4-week washout phase . Outcome measures included measures of repetitive behaviors and global improvement . Low-dose liquid fluoxetine ( mean final dose : 9.9±4.35 mg/day ) was superior to placebo in the treatment of repetitive behaviors by CY-BOCS compulsion scale . The effect size was in the moderate to large range , and the doses used were low . Liquid fluoxetine was only slightly , and not significantly , superior to placebo on CGI autism score partially due to a phase order effect . However , fluoxetine was marginally superior to placebo on a composite measure of global effectiveness . Liquid fluoxetine did not significantly differ from placebo  on treatment emergent side effects . Liquid fluoxetine in low doses is more effective than placebo in the treatment of repetitive behaviors in childhood autism . Limitations include small sample size and the crossover design of the study . Further replication and long-term maintenance trials are needed The Studies to Advance Autism Research and Treatment Network conducted a r and omized trial with citalopram in children with Pervasive developmental disorders ( PDDs ) . We present the rationale , design and sample characteristics of the citalopram trial . Subjects ( 128 boys , 21 girls ) had a mean age of 9.3 ( ±3.12 ) years ; 132 ( 88.6 % ) were diagnosed with autistic disorder ( 4.7 % with Asperger ’s Disorder ; 6.7 % with PDD-not otherwise specified ) . Less than half of the subjects were intellectually disabled ; 117 ( 78.5 % ) were rated Moderate or Marked on the Clinical Global Impression for Severity . Study measures were similar to previous Research Units on Pediatric Psychopharmacology trials . Subjects in this trial were slightly older and more likely to have complaints of repetitive behavior  than participants in RUPP trials OBJECTIVE . The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use . METHODS . This cross-sectional study used Medicaid cl aims for calendar year 2001 from all 50 states and Washington , DC , to examine 60641 children with an autism spectrum disorder diagnosis .  Logistic regression with r and om effects was used to examine the child , county , and state factors associated with psychotropic medication use . RESULTS . Of the sample , 56 % used at least 1 psychotropic medication , 20 % of whom were prescribed ≥3 medications concurrently . Use was common even in children aged 0 to 2 years ( 18 % ) and 3 to 5 years ( 32 % ) . Neuroleptic drugs were the most common psychotropic class ( 31 % ) , followed by antidepressants ( 25 % ) and stimulants ( 22 % ) . In adjusted analyses , male , older , and white children ; those who were in foster care or in the Medicaid disability category ; those who received additional psychiatric diagnoses ; and those who used more autism spectrum disorder services were more likely to have  used psychotropic drugs  . Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications . CONCLUSIONS . Psychotropic medication use is common among even very young children with autism spectrum disorders . Factors unrelated to clinical presentation seem highly associated with prescribing practice s. Given the limited evidence base , there is an urgent need to assess the risks , benefits , and costs of medication use and underst and the local and national policies that affect medication use We examined the construction of the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and performance of subscale items based on data from 204 patients with obsessive-compulsive disorder ( OCD ) who participated in a multicenter drug treatment study . Factor analysis was used to examine the relationship among the 10 items that make up the Y-BOCS instrument . Models were computed in which both two- and three-factor solutions were estimated . Within the two-factor solution analyses , the factor distribution was not so consistent as in the three-factor solution analyses , and a shift in the factor distribution was noted after treatment . In the three-factor solution analyses , an independent resistance construct emerged in addition to the obsessive and compulsive constructs . Examination of the postreatment factor scores showed that the Y-BOCS resistance items did not assess OCD symptom change as sensitively as the rest of the Y-BOCS items did BACKGROUND Atypical antipsychotic agents , which block postsynaptic dopamine and serotonin receptors , have advantages over traditional antipsychotic medications in the treatment of adults with schizophrenia and may be beneficial in children with autistic disorder who have serious behavioral disturbances . However , data on the safety and efficacy of atypical antipsychotic agents in children are limited . METHODS We conducted a multisite , r and omized , double-blind trial of risperidone as compared with placebo for the treatment of autistic disorder accompanied by severe tantrums , aggression , or self-injurious behavior in children 5 to 17 years old . The primary outcome measures were the score on the Irritability subscale of the Aberrant Behavior Checklist and the rating on the Clinical Global Impressions - Improvement ( CGI-I ) scale at eight weeks . RESULTS A total of 101 children ( 82 boys and 19 girls ; mean [ + /-SD ] age , 8.8+/-2.7 years ) were r and omly assigned to receive risperidone ( 49 children ) or placebo ( 52 ) . Treatment with risperidone for eight weeks ( dose range , 0.5 to 3.5 mg per day ) result ed in a 56.9 percent reduction in the Irritability score , as compared with a 14.1 percent decrease in the placebo group ( P<0.001 ) . The rate of a positive response , defined as at least a 25 percent decrease in the Irritability score and a rating of much improved or very much improved on the CGI-I scale , was 69 percent in the risperidone group ( 34 of 49 children had a positive response ) and 12 percent in the placebo group ( 6 of 52 , P<0.001 ) . Risperidone therapy was associated with an average weight gain of 2.7+/-2.9 kg , as compared with 0.8+/-2.2 kg with placebo ( P<0.001 ) . Increased appetite , fatigue , drowsiness , dizziness , and drooling were more common in the risperidone group than in the placebo group ( P<0.05 for each comparison ) . In two thirds of the children with a positive response to risperidone at eight weeks ( 23 of 34 ) , the benefit was maintained at six months . CONCLUSIONS Risperidone was effective and well tolerated for the treatment of tantrums , aggression , or self-injurious behavior in children with autistic disorder . The short period of this trial limits inferences about adverse effects such as tardive dyskinesia Clomipramine , haloperidol , and placebo were compared with baseline in the treatment of autism , and overall outcome , specific symptoms , and side effects were examined . It was hypothesized that clomipramine would be better tolerated than haloperidol and prove superior on a measure of stereotypy . Individuals with a DSM-IV diagnosis of autistic disorder ( mean age , 16.3 years ; range , 10–36 years ) were r and omly assigned , by using a Latin square design , to the following 7-week trials : placebo , clomipramine ( mean daily dose , 128.4 mg ; range , 100–150 mg ) , or haloperidol ( mean daily dose , 1.3 mg ; range , 1–1.5 mg ) . Data on 36 subjects were analyzed and taken together ; the results favored haloperidol . In those patients who were able to complete a full therapeutic trial , clomipramine proved comparable to haloperidol in terms of improvement compared with baseline . However , significantly fewer individuals receiving clomipramine versus haloperidol were able to complete the trial ( 37.5 % vs. 69.7 % , respectively ) for reasons related to both side effects and efficacy or behavior problems . In the intent-to-treat sample , which is perhaps more clinical ly relevant , only haloperidol proved superior to baseline on a global measure of autistic symptom severity , as well as specific measures for irritability and hyperactivity . Clomipramine did not seem more effective on a measure of stereotypy , nor was it better tolerated The short-term efficacy and tolerability of sertraline for adults with pervasive developmental disorders ( PDDs ) were assessed in this investigation . Forty-two adults with PDDs ( autistic disorder , N = 22 ; Asperger 's disorder , N = 6 ; and PDD not otherwise specified [ NOS ] , N = 14 ) participated in a 12-week , open-label , systematic trial of sertraline .  Behavioral ratings of repetitive symptoms , aggression , and social relatedness were obtained at baseline and after 4 , 8 , and 12 weeks of sertraline administration . Twenty-four ( 57 % ) of 42 patients showed significant improvement , primarily in repetitive and aggressive symptoms . Statistically significant changes in measures of social relatedness did not occur . Patients with autistic disorder and PDD NOS did significantly better than those with Asperger 's disorder . Based on global improvement item criteria from the Clinical Global Impression Scale , 15 of 22 ( 68 % ) patients with autistic disorder , none of six ( 0 % ) patients with Asperger 's disorder , and 9 of 14 ( 64 % ) patients with PDD NOS were categorized as treatment responders . Sertraline was well tolerated ; no adverse cardiovascular effects , extrapyramidal symptoms , or seizures were identified . These findings suggested that sertraline may be an effective treatment for interfering repetitive and aggressive symptoms in adults with PDDs . Definitive statements about the efficacy and tolerability of sertraline for treating adults with PDDs must await results from double-blind , placebo-controlled trials . These preliminary results should not be generalized to include children and adolescents with PDDs BACKGROUND Autistic disorder is characterized by a fundamental disturbance in social interaction , impairments in communication , and a markedly restricted repertoire of activities and interests . Abnormalities in the serotonin neurotransmitter system have been identified in some persons with autism . No consistently effective and safe drugs have been developed for treating the symptoms of autism . METHODS Thirty adults with autistic disorder completed a 12-week double-blind , placebo-controlled trial of the potent and selective serotonin uptake inhibitor fluvoxamine maleate . Behavioral ratings were obtained at baseline and after 4 , 8 , and 12 weeks of treatment . RESULTS Eight ( 53 % ) of 15 patients in the fluvoxamine-treated group were categorized as responders compared with none of 15 in the placebo group ( P = .001 ) . Fluvoxamine was superior to placebo in reducing repetitive thoughts and behavior ( P < .001 ) , maladaptive behavior ( P < .001 ) , and aggression ( P < .03 ) , and in improving some aspects of social relatedness ( P < .04 ) , especially language usage ( P < .008 ) . Treatment response was not correlated with age level of autistic behavior , or full-scale IQ . Other than mild sedation and nausea in a few patients , fluvoxamine was well tolerated . No dyskinesias , adverse cardiovascular events , or seizures occurred . CONCL 
    Output:
    