Consensus Report on Impulsive Aggression as a Symptom Across Diagnostic Categories in Child Psychiatry

Jensen, Peter S.; Youngstrom, Eric A.; Steiner, Hans; Findling, Robert L.; Meyer, Roger E.; Malone, Richard P.; Carlson, Gabrielle A.; Coccaro, Emil F.; Aman, Michael G.; Blair, James; Dougherty, Donald M.; Ferris, Craig F.; Flynn, Laurie M.; Green, Evelyn; Hoagwood, Kimberly; Hutchinson, Janice; Laughren, Tom; Leve, Leslie D.; Novins, Douglas K.; Vitiello, Benedetto

doi:10.1097/chi.0b013e31802f1454

Cited by 142 publications

(177 citation statements)

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“…We selected the MOAS as a primary dimensional outcome measure because it reflects the construct of reactive aggression ( Jensen et al 2007;Knapp et al 2012) and it has been sensitive to change in clinical studies for children with aggressive behavior (Malone et al 2000;Saxena et al 2006;Blader et al 2009). The scale items are grouped in four categories: 1) Verbal aggression, 2) aggression against objects, 3) self-directed aggression, and 4) aggression against others.…”

Section: Primary Outcome Measuresmentioning

confidence: 99%

“…The aims of the study are to examine the association of aggression with the neural correlates of emotion regulation, social perception, and reward processing in the context of a randomized controlled trial. In clinically referred samples, virtually any childhood psychiatric disorder confers elevated risk for aggressive behavior ( Jensen et al 2007), underscoring the relevance of a dimensional approach to aggression across diagnostic categories as advocated by the RDoC project. Therefore, we designed this study to examine whether reduction of aggressive behavior after treatment with CBT is paralleled by the changes in the brain circuitry of aggression.…”

Section: Introductionmentioning

confidence: 99%

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Neural Mechanisms of Cognitive-Behavioral Therapy for Aggression in Children and Adolescents: Design of a Randomized Controlled Trial Within the National Institute for Mental Health Research Domain Criteria Construct of Frustrative Non-Reward

Sukhodolsky

Wyk

Eilbott

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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Objective: We present the rationale and design of a randomized controlled trial of cognitive-behavioral therapy (CBT) for aggression in children and adolescents, which is conducted in response to the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) approach initiative. Specifically, the study is focused on the brain-behavior associations within the RDoC construct of frustrative non-reward. On the behavioral level, this construct is defined by reactions elicited in response to withdrawal or prevention of reward, most notably reactive aggression. This study is designed to test the functional magnetic resonance (fMRI) and electrophysiological (EEG) correlates of aggression and its reduction after CBT. Methods: Eighty children and adolescents with high levels of aggression across multiple traditional diagnostic categories, ages 8-16, will be randomly assigned to receive 12 sessions of CBT or 12 sessions of supportive psychotherapy. Clinical outcomes will be measured by the ratings of aggressive behavior collected at baseline, midpoint, and endpoint evaluations, and by the Improvement Score of the Clinical Global Impressions Scale assigned by an independent evaluator (blinded rater). Subjects will also perform a frustration-induction Go-NoGo task and a task of emotional face perception during fMRI scanning and EEG recording at baseline and endpoint. Results: Consistent with the NIMH strategic research priorities, if functional neuroimaging and EEG variables can identify subjects who respond to CBT for aggression, this can provide a neuroscience-based classification scheme that will improve treatment outcomes for children and adolescents with aggressive behavior. Conclusions: Demonstrating that a change in the key nodes of the emotion regulation circuitry is associated with a reduction of reactive aggression will provide evidence to support the validity of the frustrative non-reward construct.

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Section: Primary Outcome Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neural Mechanisms of Cognitive-Behavioral Therapy for Aggression in Children and Adolescents: Design of a Randomized Controlled Trial Within the National Institute for Mental Health Research Domain Criteria Construct of Frustrative Non-Reward

Sukhodolsky

Wyk

Eilbott

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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“…[1][2][3] It is classified as a psychopathological symptom when not an adaptive behavior, as well as when it clearly clashes with cultural standards of the social group to which the child or adolescent belongs. 4 Neurobiologically, impulsive/affective aggression may be explained as a lack of equilibrium between prefrontal mechanisms of top-down control (orbitofrontal cortex and anterior gyrus cinguli) and the bottom-up limbic stimuli (amygdala and other limbic areas), in which several neurotransmitters, such as serotonin, dopamine, noradrenalin and others, may be involved and may, therefore, be managed pharmacologically. 5,6 Several studies have demonstrated that aggression is a result of the combination of socioenvironmental, psychological and biological factors, and that an environment favorable to personal development may modulate unfavorable genetic characteristics.…”

Section: Introductionmentioning

confidence: 99%

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Teixeira

Jacintho

Celeri

et al. 2013

Trends Psychiatry Psychother.

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Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use. Keywords: Aggression, violence, atypical antipsychotics, behavioral disorders, children, adolescents. ResumoObjetivo: Realizar uma revisão sistemática da literatura científica sobre o uso de antipsicóticos atípicos (APAs) no tratamento da agressividade patológica em crianças e adolescentes. Método: Foi realizada busca eletrônica nas bases de dados MEDLINE, SciELO e LILACS, de 1992 a agosto 2011, considerando artigos publicados em língua inglesa e portuguesa. Foram utilizadas associações das seguintes expressões: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behaviour, aggression e violent behavior. Resultados: Foram identificados 67 artigos de boa qualidade metodológica, de relevância e interesse clínico para o tema em foco. De modo geral, os estudos são relativamente limitados para esta faixa etária, resultado do fato de poucos APAs terem sido aprovados pela Food and Drug Administration (FDA). Dentre as medicações consideradas nesta revisão (risperidona, olanzapina, quetiapina, ziprazidona, aripiprazol e clozapina), todas elas podem ter alguma efetividade no tratamento da agressividade em crianças e adolescentes, ficando a escolha baseada na indicação clínica e perfil de efeitos colaterais. Conclusão: O número ainda limitado de estudos acerca da efetividade e segurança na população pediátrica demanda pesquisas futuras com grupos maiores de pacientes e com mais categorias diagnósticas (como, por exemplo, as formas graves de transtorno de conduta e transtorno desafiador de oposição), desenhadas de forma randomizada e controlada. Assim poderão ser confirmados os achados até o momento e o impacto do uso em lo...

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“…Nevertheless, caution needs to be exercised when extending drug treatments outside diagnostic groupings, as for instance in the management of impulsive aggression. It is welcome, then, that a recent academic review highlighted this particular issue and offered advice to guide future research strategies (Jensen et al, 2007b).…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy and child psychiatry: is there a way forward?

James¹

2008

Adv. psychiatr. treat

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Recent controversy over the use of serotonin reuptake inhibitors in children and adolescents has focused attention on the role of the pharmaceutical industry in the treatment of young people. Failure of pharmaceutical companies to fully disclose negative outcome trials has led to new guidelines for publication of all trial results. Scrutiny is on the conduct of trials and the relationship of the pharmaceutical industry with prescribing doctors and posttrial surveillance of new drugs. It is argued that drug treatments in child psychiatry are a powerful therapeutic tool but vigilance is needed to ensure that data on the efficacy and safety of drugs are freely available.Anthony James is a consultant child and adolescent psychiatrist at Highfield Adolescent Unit (Warneford Hospital, Oxford OX3 7JX, UK. Email: tony.james@obmh.nhs.uk) and Honorary Senior Lecturer at the University of Oxford. His research interests include neuroimaging of earlyonset psychosis, obsessive-compulsive disorder and eating disorders.

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Consensus Report on Impulsive Aggression as a Symptom Across Diagnostic Categories in Child Psychiatry

Cited by 142 publications

References 50 publications

Neural Mechanisms of Cognitive-Behavioral Therapy for Aggression in Children and Adolescents: Design of a Randomized Controlled Trial Within the National Institute for Mental Health Research Domain Criteria Construct of Frustrative Non-Reward

Neural Mechanisms of Cognitive-Behavioral Therapy for Aggression in Children and Adolescents: Design of a Randomized Controlled Trial Within the National Institute for Mental Health Research Domain Criteria Construct of Frustrative Non-Reward

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Pharmacotherapy and child psychiatry: is there a way forward?

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