{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:12:37Z","timestamp":1793301157514,"version":"4.5.0"},"reference-count":54,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior \u2013 Brasil","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"https:\/\/ror.org\/00x0ma614","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Hospital de Cl\u00ednicas de Porto Alegre","award":["Research Incentive Fund"],"award-info":[{"award-number":["Research Incentive Fund"]}],"id":[{"id":"https:\/\/ror.org\/010we4y38","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Child and Adolescent Psychopharmacology"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Severe disruptive behaviors in youth with autism spectrum disorder (ASD) frequently persist despite conventional treatments, contributing to functional impairment. Although clozapine has antiaggressive properties, evidence guiding its use in treatment-resistant cases in autistic youth remains predominantly observational and retrospective. This study aimed to evaluate systematically and prospectively the effectiveness and safety of clozapine for treatment-resistant disruptive behaviors (TR-DB) in youth with ASD under routine conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This single-arm, open-label trial enrolled participants aged 10\u201317 with ASD. Inclusion required TR-DB after \u22652 antipsychotic trials and a Clinical Global Impression\u2013Severity score \u22655. Following flexible titration, clozapine was maintained for 12 weeks. The primary outcome was change on the caregiver-rated Aberrant Behavior Checklist\u2013Irritability (ABC-I). Secondary measures included global improvement, autism symptom severity, adaptive behavior, and caregiver quality of life. Response was defined as \u226530% ABC-I reduction plus a CGI\u2013Improvement (CGI-I) of 1 to 2; remission required \u226580% ABC-I reduction and a CGI-I of 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-one participants initiated clozapine treatment (mean age 13.4 years; 90.3% male), and 28 completed the trial. ABC-I scores decreased from 32.0 \u00b1 7.7 to 7.4 \u00b1 5.1 (Cohen\u2019s d\n                      <jats:sub>z<\/jats:sub>\n                      \u22122.5;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Overall, 83.9% responded, and 38.7% remitted. Global severity improved from 6.1 \u00b1 0.6 to 3.8 \u00b1 1.6 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Significant improvements were observed in daily living skills, caregiver quality of life, and reduced polypharmacy. Adverse drug reactions were mostly mild-to-moderate; however, metabolic changes comprised significant weight gain and triglyceride elevation (both\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). Serious events included seizures (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 4) and pneumonia (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Clozapine was associated with robust, rapid TR-DB reductions and high retention in autistic youth. However, safety risks mandate rigorous monitoring. Controlled trials are needed to confirm efficacy and refine the benefit\u2013risk profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10445463261467155","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:57:37Z","timestamp":1784872657000},"page":"617-630","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clozapine for Severe Treatment-Resistant Disruptive Behaviors in Youth with Autism Spectrum Disorder: A Prospective Real-World Interventional Study"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4677-3562","authenticated-orcid":false,"given":"Andr\u00e9 Luiz Schuh Teixeira","family":"da Rosa","sequence":"first","affiliation":[{"name":"Graduate Program of Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."},{"name":"Division of Child and 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