Systematic review of pharmacotherapy of disruptive behavior disorders in children and adolescents

Abstract

There are relatively few controlled trials of the pharmacotherapy of disruptive behavior disorders or other impulse control disorders, despite the importance of research in this area. Given the potential adverse effects of agents such as lithium and risperidone, a careful risk-benefit analysis is needed for each patient.

Predictors of Nonresponse to Psychosocial Treatment in Children and Adolescents with Disruptive Behavior Disorders

“…A multimodal approach including individual sessions to improve social skills and self-control strategies and family and school interventions within a comprehensive program is considered the best psychosocial intervention to meet the complex needs of these patients. Especially when aggression is the main symptom, and/or when comorbidity is heavier, medications can improve some maladaptive behaviors and increase the person's ability to benefit from nonpharmacologic interventions (Masi et al 2006(Masi et al , 2009Ipser and Stein 2007).…”

Effectiveness of Lithium in Children and Adolescents with Conduct Disorder

“…fit from nonpharmacological interventions, particMalone et al [7] explored the efficacy of medularly when aggression is the main symptom and/or ication in 40 children and adolescents (33 males and when co-morbidity plays a more important role. [4] 7 females; age range 10-17 years; mean age Mood stabilizers and atypical antipsychotics are oft-12.5 years) randomized to lithium (mean serum en prescribed, together with antidepressants and concentration 1.07 ± 0.19 mEq/L [range 0.78 to psychostimulants less frequently, but efficacy data 1.55 mEq/L]) or placebo. After 4 weeks of treatare scarce.…”

Response to treatments in youth with disruptive behavior disorders

“…Especially when aggression is the main symptom, and/or when comorbidity is heavier, medications can improve some maladaptive behaviors and increase the person's ability to benefit from non-pharmacologic interventions [11]. Mood stabilizers and atypical antipsychotics are frequently used, but antidepressants and psycho-stimulants are also administered, although efficacy data are scarce [11]. A recent review explored efficacy and safety of atypical antipsychotics in children and adolescents with DBDs, according to randomized controlled trials, concluding that limited evidence supports only short-term efficacy of risperidone [12].…”

“…However, the outcomes of these interventions have shown enormous variability in improving externalizing problems, and severe behavior disorders are frequently refractory to such approaches [6,10]. Especially when aggression is the main symptom, and/or when comorbidity is heavier, medications can improve some maladaptive behaviors and increase the person's ability to benefit from non-pharmacologic interventions [11]. Mood stabilizers and atypical antipsychotics are frequently used, but antidepressants and psycho-stimulants are also administered, although efficacy data are scarce [11].…”