Juvenile maladaptive aggression: A review of prevention, treatment, and service configuration and a proposed research agenda
ABSTRACT 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.
- SourceAvailable from: Gabrielle A Carlson
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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. "
ABSTRACT: The focus of this paper is to explore how a developmental perspective can advance understanding of the clinical trajectory into bipolar disorder (BD) and clarify controversies regarding the diagnosis in youth. In this selective review, we focus on findings from longitudinal studies of general population and high-risk pediatric cohorts in order to inform our understanding of the development of BD in youth. Also highlighted are related aspects of the debate about the diagnosis in young children and a discussion of the implications of the findings for advancing early detection and intervention clinical and research efforts. Evidence overwhelmingly suggests that BD typically onsets in adolescence and early adulthood, with the depressive polarity of the illness dominating the early course. Non-specific childhood antecedents have been noted in some high-risk individuals. However, in youth without a confirmed familial risk of BD, manic-like symptoms have little prognostic significance for BD and not uncommonly form part of the normative adolescent experience. Over-emphasis of symptoms and reliance on parent report alone, alongside the relative neglect of the child's developmental stage and risk profile, contributes to the over diagnosis in young children and under recognition of BD early in the clinical course. Longitudinal population and high-risk studies over development have made major contributions to our understanding of the early natural history of BD in youth. Implications call for a different diagnostic approach to facilitate accurate identification of youth in the early clinical stages of psychiatric disorders and to differentiate between the emerging illness trajectories and transient normative symptoms in childhood and adolescence.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). "
ABSTRACT: The present study investigates the clinical long-term outcomes (2½ to 4 years post-discharge) of children aged 12 and under with a primary diagnosis of a Disruptive Behaviour Disorder (DBD) who attended a short-term day treatment program using best-practice treatment strategies. This study compared children's admission, discharge, and follow-up test scores on standardized measures of behaviour and functioning, as rated by parents. Measures of clinical symptoms in the children and parent report of stress were used. To test for treatment effects across time, two repeated-measures ANOVAs were calculated. There was significant treatment change across time points on measures of social problems, externalizing symptoms, levels of aggression, intensity of problems, and symptoms of ADHD. Children with DBD who attended a short-term day treatment program using best-practice treatment strategies showed significant improvement in their behaviour at home. These improvements were relatively long lasting. The current study lends support to the effectiveness of day treatment and the idea that severe DBD can be treated using multi-modal, intensive, and evidence-based treatment techniques resulting in long-term change.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). "
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