Finding a safe and effective treatment for children with ADHD who are a physical threat to others is a difficult and trying experience for families.
For most aggressive children with attention-deficit/hyperactivity disorder (ADHD), the combination of stimulation therapy and behavioral management training for parents reduces their violent behaviors. Yet, some children remain a threat.
Earlier research has suggested that additional medication may help alleviate the aggression, but it has been unknown whether or not the dual-drug strategy is effective and safe.
A new study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, looked at 168 children ages 6 to 12 who were diagnosed with ADHD and disruptive behavior disorder and who displayed significant physical aggression. The children were divided into two groups, “basic” and “augmented.”
All study participants received a stimulant drug called OROS methylphenidate, and their parents received training in behavior management procedures for nine weeks. This combination treatment is called “basic” because both are evidence-based and have been shown to be helpful for improving both ADHD and aggression.
To augment the effectiveness of basic treatment, the “augmented” group received a second medication—the antipsychotic drug risperidone.
The study results showed that compared to the “basic group,” the “augmented group,” who received the stimulant medication and parent training plus risperidone, showed significant improvement (on average with moderately better behavior) in anger, irritability, and aggression according to parents.
Parents also reported that children receiving augmented therapy were less likely to be impaired socially or academically by their anger and irritability than children receiving basic therapy.
“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,” says Kenneth Gadow, professor of psychiatry at Stony Brook University.
“But it is very important for practitioners to document behavioral change,” he says. “We are continuing to analyze our data to determine if these short-term benefits are maintained over a longer time interval.”
Researchers from University of Pittsburgh, Case Western Reserve University, and Ohio State University were coauthors of the study. The National Institute of Mental Health and the National Institutes of Health General Clinical Research Center funded the research.
Source: Stony Brook University