Drugs

Stimulants And Antipsychotic Drugs Combined Help Physically Aggressive Kids With ADHD

ADHD
Prescribing a stimulant plus an antipsychotic drug to violent kids with ADHD reduces their aggression when combined with teaching parents to use behavior management techniques. Photo courtesy of Shutterstock.

What can a parent do about a violent child? Among the most common reasons parents bring a child to a mental health clinic is aggression — and their own inability to control their child’s destructive behavior. Now, a new study spearheaded by researchers at Stony Brook University School of Medicine finds prescribing both a stimulant plus an antipsychotic drug to children with attention-deficit/hyperactivity disorder (ADHD) and unmanageable levels of aggression reduces their aggression when combined with teaching parents to use behavior management techniques.

Drugging children is controversial at best, yet some children, in particular those already diagnosed with ADHD, can be a threat to their siblings, other children, and even adults. The combination of stimulation therapy and behavioral management training for parents reduces the destructive actions of some children with ADHD. However, this treatment doesn’t work for all kids. While one theory suggests an additional medication might help, many doctors and parents are wary of a dual-drug strategy, worrying it might not be safe or even effective.

To investigate a double-drug approach, researchers from Stony Brook, with the help of colleagues at Ohio State University, University of Pittsburgh, and Case Western Reserve University, designed the TOSCA study: Treatment of Severe Childhood Aggression. The team began by enrolling 168 children between ages 6 and 12 who had been diagnosed with ADHD and disruptive behavior disorder. Next, the researchers divided these children, all having demonstrated significant physical aggression, into two groups.

For nine weeks, the children in the “basic” group received a stimulant drug called OROS methylphenidate while their parents received training in behavior management procedures. Participants in the second “augmented” group and their parents received the same drug and training as those in the basic group, yet these children received a second medication as well: risperidone, an antipsychotic drug.

What did the researchers observe during the nine week period? “Augmented therapy was superior to Basic therapy,” wrote the authors in the conclusion of their study in reducing severity of ADHD symptoms, peer aggression, oppositional defiant disorder symptoms, and symptom-induced impairment at home or at school. According to parents, the children receiving augmented therapy were less likely to be socially or academically impaired by their anger than their peers in the basic therapy group. However, teachers had a somewhat different opinion of the children in the TOSCA study. They rated augmented therapy as providing a greater reduction in ADHD severity, but thought it was not as effective in quelling symptoms of oppositional defiant disorder, conduct disorder, or, most importantly, peer aggression.

“The take home message is that augmenting stimulant medication and parent training in behavior management with risperidone may result in additional behavioral improvement in aggression, anger, and irritability over the short-term for children who really require a second medication,” said Dr. Kenneth Gadow, professor of psychiatry. Perhaps, though, even a short-term fix could provide time enough to spur developmental changes in a destructive child.

Source: Gadow KD, Arnold LE, Molina BSG, et al. Risperidone Added to Parent Training and Stimulant Medication: Effects on Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Peer Aggression. Child and Adolescent Psychiatry. 2014.

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