Juvenile maladaptive aggression: A review of prevention, treatment, and service configuration and a proposed research agenda

Department of Psychiatry/MC1410, University of Connecticut Health Center, Farmington 06030-1410, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2006; 67(5):808-20. DOI: 10.4088/JCP.v67n0516
Source: PubMed


To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry.
Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies.
Articles met the following criteria: published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance.
Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed.
Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations.
Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.

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    • "The answer to why doctors have gravitated to using AAPs in these patients seems simple. Even though there is no formal United States Food and Drug Administration (FDA) approval, there is an extensive database that has been quantified in meta-analyses (e.g., Connor et al. 2002; Pappadopulos et al. 2006) and treatment guidelines (e.g., Pliszka et al. 2006). Although there are no head-tohead studies, those meta-analyses suggest that despite their flaws, neuroleptics work better than lithium or anticonvulsants as adjunctive medications, especially when irritability, rage, or explosive behavior are the targets of the intervention. "
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    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 02/2013; 22(1):6-12.
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    • "Psychopharmacological treatment, especially the use of stimulants to treat ADHD and risperidone to treat aggression (Pappadopulos et al. 2006), has also been found to be an effective component of treatment. Programs combining these interventions show the most success in treating severe DBD (Burke, Loeber, & Birmaher, 2002; Connor et al., 2006). "
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    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 08/2012; 21(3):204-12.
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    • "In addition, APDs are increasingly used to treat non-psychotic disorders, such as autism spectrum disorders, oppositional personality disorder, Tourette Syndrome, attention deficit hyperactivity disorder (ADHD), and pervasive developmental disorder. APDs are also increasingly used to treat oppositional, irritable, and aggressive behaviors across diagnoses (Connor et al., 2006; Cooper et al., 2006), with limited evidence to support such off-label use. Children who are publicly insured (e.g., Medicaid) are more commonly prescribed psychotropic medications than privately insured children (Olfson et al., 2002), and children in foster care who are publicly insured represent the population of publicly insured children with the greatest likelihood of being prescribed psychotropic medications (Zito et al., 2008; Dosreis et al., 2011). "
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    ABSTRACT: Although offering many benefits for several psychiatric disorders, antipsychotic drugs (APDs) as a class have a major liability in their tendency to promote adiposity, obesity, and metabolic dysregulation in an already metabolically vulnerable population. The past decade has witnessed substantial research aimed at investigating the mechanisms of these adverse effects and mitigating them. On July 11 and 12, 2011, with support from 2 NIH institutes, leading experts convened to discuss current research findings and to consider future research strategies. Five areas where significant advances are being made emerged from the conference: (1) methodological issues in the study of APD effects; (2) unique characteristics and needs of pediatric patients; (3) genetic components underlying susceptibility to APD-induced metabolic effects; (4) APD effects on weight gain and adiposity in relation to their acute effects on glucose regulation and diabetes risk; and (5) the utility of behavioral, dietary, and pharmacological interventions in mitigating APD-induced metabolic side effects. This paper summarizes the major conclusions and important supporting data from the meeting.
    Frontiers in Psychiatry 06/2012; 3:62. DOI:10.3389/fpsyt.2012.00062
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