Purboyo Soleka*, Uni Gamayanib, Kusnandi Rusmila, Irvan Afriandic, Taufan Prasetyaa, Anggia Farrah Rizqiamutia, Eka Nurfitria, Burhana, Indra Sahrila, Kevin Gunawand
aDepartment of Child Health, Faculty of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia, bDepartment of Neurology, Faculty of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia, cDepartment of Public Health, Faculty of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia, dFaculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: This study aimed to investigate the core symptom of autism in Indonesian children using Childhood Autism Rating Scale (CARS) scores and their relationship with cognitive profiles while evaluating the effectiveness of aripiprazole and behavioral intervention across different cognitive levels. Materials and Methods: A multicenter, randomized, double‑blind, placebo‑controlled trial was conducted in Bandung City, Indonesia, from February 2023 to January 2024. Participants aged 6–10 years with autism spectrum disorder (ASD) were assessed using CARS and Stanford‑Binet Intelligence Scales Form L‑M. They were randomized to receive either aripiprazole with behavioral therapy (BT) or placebo with BT for 12 weeks. CARS scores and cognitive levels were evaluated at baseline and after treatment. Results: The study enrolled 51 participants (29 placebo and 22 aripiprazole). Both groups showed significant improvements in CARS and cognitive scores over 12 weeks. The aripiprazole group demonstrated greater reductions in CARS scores (5.17 points for higher‑cognitive level [HC‑ASD]; 4.88 points for lower‑cognitive level [LC‑ASD] compared to the placebo group. Significant improvements were observed in visual response, taste/smell/touch response, and fear/nervousness CARS subcategories (P < 0.05). Receiver operating characteristic analysis revealed that CARS scores at end‑of‑treatment (EoT) were strong predictors of cognitive improvement, with an optimal cutoff of 36.25 achieving high sensitivity and specificity (AUC 0.776, P < 0.05). Conclusion: Early identification, accurate differentiation between LC‑ASD and HC‑ASD, and targeted interventions combining pharmacological treatment with BT are essential for improving outcomes in children with ASD. These approaches can reduce symptom complexity while fostering long‑term functional skills development.
Keywords: Aripiprazole, Autism spectrum disorder, Behavioral therapy, Childhood
autism rating scale, Cognitive level
