Treatment of Maladaptive Aggression in Youth: CERT Guidelines II. Treatments and Ongoing Management

Abstract

Treatment of children with maladaptive aggression is a "moving target" requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.

The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers

“…In the T-MAY guidelines developed through the CERT, the authors performed a systematic review of psychosocial interventions for aggression in youth. 30 The most-studied interventions for children 8 years of age and younger were found to be group parent training treatment programs, with an effect size of 0.50 to 0.83, and multicomponent treatment approaches (involving a combination of positive parenting, interpersonal and social skills for children, and classroom management for teachers), with an effect size of 0.23 to 0.38. 30 Psychosocial interventions for children older than 8 years included 3 different approaches.…”

“…30 The most-studied interventions for children 8 years of age and younger were found to be group parent training treatment programs, with an effect size of 0.50 to 0.83, and multicomponent treatment approaches (involving a combination of positive parenting, interpersonal and social skills for children, and classroom management for teachers), with an effect size of 0.23 to 0.38. 30 Psychosocial interventions for children older than 8 years included 3 different approaches. Brief strategic family therapy to modify family interactions had an effect size of 0.68; multisystemic therapy to increase family communication, parenting skills, and peer relationships had an effect size of 0.25; and cognitive-behavioural therapy had an effect size of 0.58 and demonstrated sustained reduction in anger episodes several months after the intervention.…”

“…Brief strategic family therapy to modify family interactions had an effect size of 0.68; multisystemic therapy to increase family communication, parenting skills, and peer relationships had an effect size of 0.25; and cognitive-behavioural therapy had an effect size of 0.58 and demonstrated sustained reduction in anger episodes several months after the intervention. 30 Based on the above evidence, the CERT T-MAY guidelines make strong recommendations for psychoeducation and the provision of age-appropriate, evidence-based parent and child skills training during all phases of care. As the effect sizes demonstrated for these psychosocial therapies are in the same range as the effect sizes of most medications assessed in our systematic review, clinicians should be encouraged to recommend psychosocial therapy as initial management of disruptive and aggressive behaviour in children with ADHD, ODD, or CD.…”

Canadian Guidelines on Pharmacotherapy for Disruptive and Aggressive Behaviour in Children and Adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, or Conduct Disorder

“…6,7 These guidelines have many strengths, including their comprehensive scope, the contributors' expertise, and the rigorous methods for grading recommendations. A particularly important finding of the T-MAY literature review is that substantial evidence supports the use of psychosocial interventions, with Lignes directrices de la pharmacothérapie du comportement perturbateur et agressif chez les enfants et adolescents souffrants du trouble de déficit de l'attention avec hyperactivité, du trouble oppositionnel avec provocation, ou du trouble des conduites Objectif : Élaborer des lignes directrices fondées sur les données probantes de la pharmacothérapie du comportement perturbateur et agressif chez les enfants et adolescents souffrant du trouble de déficit de l'attention avec hyperactivité (TDAH), du trouble oppositionnel avec provocation (TOP), ou du trouble des conduites (TC).…”

Pharmacological Treatment of Child and Adolescent Disruptive Behaviour Disorders: Between the Scylla and Charybdis, What Do the Data Say?

“…It is important, as the authors do, to remind the clinician that first-line treatment for children and adolescents with severe oppositional behaviour, conduct problems, and aggression should be psychosocial interventions, 8 which are supported by substantial evidence and have low risks for adverse effects. This is even more critical when we consider the causal role childhood adversity plays with many childhood mental health problems and in the comorbidity of the traumatic spectrum disorders with our patients with ADHD, ODD, and CD.…”