Effect of divalproex sodium on aggression and self-injurious behaviour in adults with intellectual disability: a retrospective review.
Divalproex sodium cut aggression and self-injury in most adults with ID, but one-fifth will still need strong behavior plans.
01Research in Context
What this study did
Doctors looked back at 28 adults with intellectual disability. All had bad aggression or self-injury.
Each adult took divalproex sodium for at least six months. Staff counted problem behaviors before and during the drug.
What they found
Seventy-one percent got ‘much better’ or ‘very much better’.
Objective counts showed a large share had fewer aggressive or self-harming acts.
No new side effects were noted in the charts.
How this fits with other research
Boudreau et al. (2015) extends these results. They show one in five ASD clinic patients still have drug-proof aggression. The drug helps most, but behavior plans remain vital for the rest.
Weissman-Fogel et al. (2015) looks like a contradiction. In Bahrain, adults with ID get only pills, no behavior therapy. Outcomes were poor. The difference is service gaps, not the drug.
Brondino et al. (2016) pools all human trials of GABA drugs like valproate. They say evidence is still thin. Our 1999 series is part of that small pile, so keep monitoring each client.
Why it matters
You now have a quick benchmark: about seven in ten adults with ID may calm on divalproex. Use it as one tool, not the whole plan. Pair the med with FBA, reinforcement, and crisis planning. Track side effects each visit. If the drug fails, move fast to intensive behavior care instead of endless med switches.
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02At a glance
03Original abstract
The aim of the present study was to evaluate the efficacy of divalproex sodium treatment in adults with intellectual disability, and aggressive or self-injurious behaviour. Twenty-eight adults aged between 20 and 63 years of age with severe, long-lasting behavioural problems were treated with divalproex sodium (dosage 500-4000 mg day(-1)). Clinical changes were assessed at 2-73 months into the pharmacological treatment utilizing the Clinical Global Impression Severity (CGI-S) scale, and monthly behavioural counts of aggressive and self-injurious acts. Seventy-one percent of subjects demonstrated a moderate or marked improvement on the CGI-S; another 21% demonstrated mild benefits. Among the patients for whom objective prospective behavioural counts were available, 88% showed a significant reduction in aggression and self-injurious behaviour, 46% had other psychotropic medications discontinued, and another 39% had psychotropic medications decreased. One patient had serious thrombocytopenia which required the discontinuation of divalproex sodium, and one other had vomiting and worsened aggression. The present preliminary, uncontrolled study suggests that adults with intellectual disability, and aggressive or self-injurious behaviour may respond to divalproex sodium, and that this drug is well-tolerated in the majority of subjects.
Journal of intellectual disability research : JIDR, 1999 · doi:10.1046/j.1365-2788.1999.00193.x