Aggressive Kids With ADHD May Not Need Antipsychotic Meds

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Aggressive Kids With ADHD May Not Need Antipsychotic Meds

Study suggests judicious tweaking of stimulant drugs, plus psychotherapy, may be

enough

By Madonna Behen

HealthDay Reporter

HealthDay/ScoutNews LLC

FRIDAY, Sept. 17 (HealthDay News) -- More and more children with

attention-deficit/hyperactivity disorder (ADHD) who act out aggressively are

being given antipsychotic drugs in addition to stimulant medications to help

control their volatile outbursts.

It's a trend that many parents and child mental health professionals find

worrisome.

However, a new study by researchers at New York's Stony Brook University School

of Medicine suggests that, with careful tweaking, use of stimulant medication

alone can significantly reduce or eliminate aggressive behavior in at least half

of these children.

" There's a big push in this country to have pediatricians manage these kinds of

behavioral difficulties in children because there's such a shortage of child

psychiatrists, " noted the study's lead author, ph C. Blader, an assistant

professor of psychiatry at Stony Brook. " I hope our study will embolden more

primary care physicians to push the limits of first-line [stimulant] treatment

for ADHD before going on to the next thing. "

The study findings were released online Sept. 13 in advance of publication in

the October print issue of Pediatrics.

Blader said the results were an unexpected finding that occurred during the

lead-in phase of a study designed to look at whether it was beneficial to give

the antipsychotic medication divalproex (Depakote) to aggressive kids with ADHD

whose volatile behavior wasn't controlled by stimulant medication alone.

The researchers followed 65 children between the ages of 6 and 13 to determine

the most effective and best-tolerated stimulant regimen for each of them. All of

the kids had ADHD plus either oppositional defiant disorder or conduct disorder,

with significant aggressive behavior. The children were started on a low dose of

triphasic-release methylphenidate (Concerta), the longest acting form of

Ritalin.

During weekly assessments, the researchers fine-tuned the dose until the child's

symptoms were well-controlled and he or she could tolerate any side effects

(mainly insomnia and loss of appetite). If Concerta wasn't the right choice, a

child was switched to either biphasic methylphenidate (Metadate) or biphasic

mixed amphetamine salt medication (Adderall XR).

Children and their parents also had weekly behavioral therapy sessions, during

which parents were encouraged to " emphasize the times when their children were

able to show self-control and manage their frustrations better, " Blader said.

" The goal was to help parents develop rewards and incentives, while at the same

time, set limits around some of the problem behaviors. "

At the end of the lead-in phase, which lasted an average of five weeks, 32 of

the children showed significant reductions in their aggressive behavior.

" I was very surprised by how many of the kids we couldn't randomize [to an

antipsychotic medication] because their aggression went away " as doctors

adjusted their type or level of stimulant drug, said Blader.

" This is an important message about hanging in there with a medication, " noted

Dr. Varley, a child psychiatrist at Seattle Children's Hospital. He said

in the last decade, there's been a dramatic increase in the use of antipsychotic

medications to reduce disruptive behavior in children, and in many cases the

drugs are not necessary.

" Sometimes you do need to use these medications, but in this day and age, the

trigger may be pulled too quickly, " said Varney, who is professor of child and

adolescent psychiatry at the University of Washington School of Medicine.

Blader said the advice for children and their parents is to not get discouraged

if the first ADHD drug and dosage doesn't work.

" Just like with asthma or many other health problems, it's often a bit of an

exercise to find what does the trick, " he said.

The researchers received funding from the U.S. National Institutes of Health and

the National Alliance for Research on Schizophrenia and Depression.

More information

Find out more about ADHD at the U.S. National Institute of Mental Health.

SOURCES: ph C. Blader, Ph.D., assistant professor, psychiatry and behavioral

science, Stony Brook University School of Medicine, Stony Brook, N.Y.;

K. Varley, M.D., professor, child and adolescent psychiatry,

University of Washington School of Medicine, Seattle, and program director,

child psychiatry residency, Seattle Children's Hospital; Sept. 13, 2010,

Pediatrics, online

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