In Reply.—

I thank Dr Kastner for his comments and agree that diagnosis must always guide treatment. Indeed, the children enrolled in this trial were known to the investigators and had careful characterization of their clinical profile in addition to trial-related procedures. A clinical determination was made for each child for whether he or she specifically could be expected to benefit from treatment with risperidone, consistent with other such research studies. All of the children included in this study were diagnosed with pervasive development disorders by experienced developmental pediatricians or child and adolescent psychiatrists, with expertise in the assessment and management of these disorders and their comorbidities. Children enrolled in this study were selected carefully; children with concomitant active health issues such as uncontrolled seizures were excluded. Behavior intervention therapy, provided it was started 30 days before randomization, could be continued during the trial. Follow-up included comprehensive review...

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