Co-morbid disruptive behavior disorder and aggression predict functional outcomes and differential response to risperidone versus divalproex in pharmacotherapy for pediatric bipolar disorder. Treating disruptive behavior disorders with risperidone: a 1-year, open-label safety study in children and adolescents. Long-term use of risperidone in children with disruptive behavior disorders and subaverage intelligence: efficacy, safety, and tolerability. Impact of treatments for depression on comorbid anxiety, attentional, and behavioral symptoms in adolescents with selective serotonin reuptake inhibitor-resistant depression. Preventive effects of treatment of disruptive behavior disorder in middle childhood on substance use and delinquent behavior. Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. Neural Correlates of the Propensity for Retaliatory Behavior in Youths With Disruptive Behavior Disorders. Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial. Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. Does oligoantigenic diet influence hyperactive/conduct-disordered children — a controlled trial Focus on aripiprazole: a review of its use in child and adolescent psychiatry. Acute and chronic administration of trazodone in the treatment of disruptive behavior disorders in children. Risperidone in children with disruptive behavior disorders and subaverage intelligence: a 1-year, open-label study of 504 patients. Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis. Randomized Trial of Parent Management Training in Children With Tic Disorders and Disruptive Behavior Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Multi-method psycho-educational intervention for preschool children with disruptive behavior: preliminary results at post-treatment. Risperidone for children and adolescents with autism spectrum disorder: a systematic review Child and adolescent problems predict DSM-IV disorders in adulthood: a 14-year follow-up of a Dutch epidemiological sample. Evaluation of a Booster Intervention Three Years After Acute Treatment for Early-Onset Disruptive Behavior Disorders Child/Adolescent Anxiety Multimodal Study (CAMS): rationale, design, and methods Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial. Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. Effectiveness of the Incredible Years Parenting Program for Families with Socioeconomically Disadvantaged and Ethnic Minority Backgrounds Training in Social Skills: An Alternative Technique for Handling Disruptive Child Behavior Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Risperidone in the Treatment of Disruptive Behavioral Symptoms in Children With Autistic and Other Pervasive Developmental Disorders The Impact of the Good Behavior Game, a Universal Classroom-Based Preventive Intervention in First and Second Grades, on High-Risk Sexual Behaviors and Drug Abuse and Dependence Disorders into Young Adulthood Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Childhood psychopathology and adolescent cigarette smoking: a prospective survival analysis in children at high risk for substance use disorders. Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment Parent–Child Interaction Therapy for Disruptive Behavior in Children with Mental Retardation: A Randomized Controlled Trial Family-focused treatment for adolescents with bipolar disorder. What does risperidone add to parent training and stimulant for severe aggression in child attention-deficit/hyperactivity disorder? Stimulant-Responsive and Stimulant-Refractory Aggressive Behavior Among Children With ADHD
OBJECTIVE Co-morbid diagnoses , such as disruptive behavior disorders ( DBDs ) and high levels of aggression , are extremely common among youth with pediatric bipolar disorder ( PBD ) and may interfere with treatment response ; however , they have rarely been examined as predictors of response to pharmacotherapy . The current study examines co-morbid DBD and aggression prospect ively as predictors of pharmacotherapy outcome , as well as potential moderators of response to a specific medication ( risperidone vs. divalproex ) , among children with PBD . METHODS Data are from a prospect i ve 6-week double-blind , placebo-controlled , r and omized outpatient medication treatment trial of risperidone versus divalproex for manic episodes in 65 children 8 - 18 with PBD . Outcome measures were administered at pretest , post-test , and weekly during the 6 weeks of treatment . Mixed-effects regression models were used to examine pharmacotherapy response . RESULTS Results indicated that youth with co-morbid DBD experienced greater improvement in manic symptoms in response to risperidone versus divalproex , whereas youth with non-co-morbid DBD experienced similar trajectories of symptom improvement in both medication groups . In addition , the non-DBD group experienced greater improvement in global functioning over time as compared with youth with co-morbid-DBD , and this gap increased over the course of treatment . Results also indicated that high-aggression youth experienced worse global functioning by end treatment versus low-aggression youth . CONCLUSIONS In conclusion , a co-morbid diagnosis of DBD and /or high levels of aggressive symptoms in youth with PBD may be important clinical predictors of variation in treatment response to pharmacotherapy . These findings may help research ers and clinicians develop tailored treatment approaches that optimize symptom and functional outcomes OBJECTIVE The aim of this study was to determine the long-term safety of risperidone as maintenance therapy in children and adolescents with disruptive behavior disorders ( DBDs ) and normal intelligence . METHOD An open-label , 1-year extension study was conducted from January , 2002 , to July , 2004 , in 232 subjects with DBDs ( 5 - 17 years ) previously r and omized to risperidone ( RIS ) ( n = 115 , RIS/RIS ) or placebo ( PLA ) ( n = 117 , PLA/RIS ) in a double-blind , 6-month withdrawal study .  Adverse events ( AEs ) and clinical laboratory test results were recorded . Efficacy was assessed using Nisonger Child Behavior Rating Form . Safety and efficacy were evaluated in the intent-to-treat population . RESULTS A total of 169/232 ( 73 % ) subjects completed the study . Subjects were predominantly male , with a diagnosis of oppositional defiant disorder . Risperidone was generally well tolerated . Weight gain and extrapyramidal symptoms were each reported as AEs by 10 subjects ( 4.3 % ) . Mean weight z-scores decreased for RIS/RIS subjects ( -0.04 + /- 0.28 ) and increased for PLA/RIS subjects ( 0.11 + /- 0.43 ) . No subject developed tardive dyskinesia . Prolactin tended to increase with risperidone , although this effect diminished with prolonged use and was infrequently associated with AEs . There were no clinical ly relevant changes in glucose or lipid metabolism . Clinical improvement in DBD symptoms was observed with flexible risperidone doses , regardless of previous treatment and whether subjects had experienced symptom recurrence . CONCLUSIONS Risperidone reinitiated for DBD in children with normal intelligence quotients ( IQ ) was safe and well tolerated over an additional year of treatment . Patients demonstrated clinical benefits , including those who previously experienced symptom recurrence OBJECTIVE The aim of this study was to assess the long-term efficacy and tolerability of risperidone in the treatment of children and adolescents with disruptive behavior disorder ( DBD ) and below-average intelligence ( IQ < 84 ) over a cumulative period of 2 years . METHODS We followed 48 patients ( 6 - 15 years of age ) , who had previously completed a 1- year open-label study of risperidone , for an additional year of treatment .  Efficacy was assessed using the conduct problem subscale of the Nisonger Child Behavior Rating Form ( N-CBRF ) as a primary outcome measure ; other N-CBRF subscales , the Aberrant Behavior Checklist ( ABC ) , and the Clinical Global Impression ( CGI ) of severity were secondary efficacy measures . Safety and tolerability were also assessed . RESULTS Of the 48 patients enrolled in this extension study , 33 ( 69 % ) completed the trial . The efficacy benefits from the original study were maintained over the course of the extension study . Safety and tolerability were good overall , with the number of adverse events ( AEs ) decreasing in the extension trial , compared to the original trial . Six patients ( 13 % ) discontinued owing to AEs . Weight gain observed in the original trial stabilized during this extension trial . Cognitive testing demonstrated small , but significant , improvements in cognitive ability . CONCLUSIONS Risperidone is safe and effective in treating DBDs in children over a cumulative period of 2 years OBJECTIVE To assess the relative efficacy of antidepressant medication , alone and in combination with cognitive behavioral therapy ( CBT ) , on comorbid symptoms of anxiety , attention , and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents ( TORDIA ) trial . METHOD Adolescents with selective serotonin reuptake inhibitor (SSRI)-resistant depression ( N = 334 ) were r and omly assigned to a medication switch alone ( to another SSRI or to venlafaxine ) or to a medication switch plus CBT .  Anxiety , attention-deficit/hyperactivity disorder ( ADHD ) , and disruptive behavior disorder ( DBD ) symptoms were assessed by psychiatric interview and self-report at regular intervals between baseline and 24 weeks . The differential effects of medication and of CBT , and the impact of remission on the course of comorbid symptoms and diagnoses , were assessed using generalized linear mixed models . RESULTS Remission was associated with a greater reduction in scalar measures of anxiety , ADHD , and DBDs , and a greater decrease in the rate of diagnosed anxiety disorders . The correlations between the changes in symptoms of depression on the CDRS-R and anxiety , ADHD , and oppositional symptoms were modest , ranging from r = 0.12 to r = 0.28 . There were no significant differential treatment effects on diagnoses , or corresponding symptoms . CONCLUSION The achievement of remission had a beneficial effect on anxiety , ADHD , and DBD symptoms , regardless of the type of treatment received . There were no differential effects of medication or CBT on outcome , except for a nonsignificant trend that those adolescents treated with SSRIs showed a greater decrease in rates of comorbid DBDs relative to those treated with venlafaxine . Clinical trial registration information-Treatment of SSRI-Resistant Depression In Adolescents ( TORDIA ) ; http:// clinical trials.gov/ ; NCT00018902 OBJECTIVE Disruptive behavior disorder ( DBD ) is a well-known risk factor for substance abuse and delinquent behavior in adolescence . Therefore , the long-term preventive effects of treatment of DBD in middle childhood on beginning substance use and delinquency in early adolescence were investigated . METHOD Children with DBD ( 8 - 13 years old ) had been r and omly assigned to manualized behavior therapy ( Utrecht Coping Power Program ; UCPP )  or to care as usual ( CU ) in the Netherl and s. Five years ( 2003 - 2005 ) after the start of treatment ( 1996 - 1999 ) , substance use and delinquency were monitored in 61 of the initial 77 adolescents and compared with a matched healthy control group by means of self-report question naires . One-factor analyses of variance and Pearson 's chi2 analyses were performed . RESULTS Differences in substance use were revealed in favor of the UCPP , with more adolescents in the CU group smoking cigarettes in the last month ( UCPP 17 % , CU 42 % ; chi2 = 4.7 ; p < .03 ) and more adolescents in the CU group having ever used marijuana ( UCPP 13 % , CU 35 % ; chi2 = 4.0 ; p < .045 ) . Moreover , in this respect , the UCPP fit in the range of the matched healthy control group . Both treatment groups were comparable to the matched healthy control group in delinquent behavior . CONCLUSIONS Manualized behavior therapy for DBD in middle childhood seems to be more powerful than CU in reducing substance use in early adolescence . Both treatment conditions show a beneficial long-term preventive effect on delinquency OBJECTIVE The aim of this study was to examine the safety and efficacy of risperidone , with or without concomitant psychostimulant use , in the treatment of children with conduct disorder ( CD ) or other disruptive behavior disorders [ oppositional defiant disorder ( ODD ) , disruptive behavior disorder-not otherwise specified ( DBD-NOS ) ] , and comorbid attention-deficit hyperactivity disorder ( ADHD ) . METHODS Data from two 6-week placebo-controlled trials assessing risperidone therapy in children with subaverage IQs and CD , ODD , DBD-NOS were combined , and patients with comorbid ADHD were selected for this post hoc analysis . Patients were grouped according to r and omized drug therapy ( risperidone or placebo ) , and then subgrouped according to their use of a concomitant psychostimulant .  Safety outcomes included adverse events and weight change , while efficacy outcomes included changes in scores on disruptive behavior and hyperactivity-based subscales of two behavior-rating instruments ( Nisonger Child Behavior Rating Form and the Aberrant Behavior Checklist ) . RESULTS The analysis included 155 of 208 originally tested children divided into four sub-groups ( 35 - 43 patients each ) . There was no significant difference in the frequency of adverse events in patients who received  risperidone  alone and those who received risperidone plus a stimulant . The most common adverse events in risperidone-treated patients were somnolence , headache , dyspepsia , rhinitis , and vomiting . Within each r and omized treatment group , actual weight gain was comparable , regardless of concomitant stimulant use . Risperidone-treated patients had clinical ly and statistically significant reductions in both disruptive behavior and hyperactivity subscale scores , compared to placebo , regardless of concomitant stimulant use . The addition of risperidone to a psychostimulant result ed in significantly better control of hyperactivity ( p < 0.001 ) than was achieved with stimulant treatment alone , without causing an increase in adverse events . CONCLUSION Risperidone was a safe and effective treatment , with or without a combined psychostimulant , for both disruptive behavior disorders and comorbid ADHD in children OBJECTIVE To determine whether risperidone is effective in reducing symptoms of disruptive behaviors ( such as aggression , impulsivity , defiance of authority figures , and property destruction ) associated with conduct disorder , oppositional defiant disorder , and disruptive behavior disorder-not otherwise specified in children with subaverage IQs . METHOD The trial consisted of a 1-week , single-blind , placebo run-in period and was followed by a 6-week , double-blind , placebo-controlled period . One hundred ten children ( aged 5 - 12 years inclusive ) with an IQ of 36 - 84 with a disruptive behavior disorder and a score of at least 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form ( NCBRF ) were enrolled . Eighty percent of subjects had comorbid attention-deficit/hyperactivity disorder ( ADHD ) .  Risperidone doses ranged from 0.02 to 0.06 mg/kg per day . Subjects were rated on the NCBRF , Aberrant Behavior Checklist , Behavior Problems Inventory , Clinical Global Impressions ( CGI ) , modified California Verbal Learning Test ( CVLT ) , and a continuous performance task ( CPT ) . RESULTS The intention-to-treat analysis of risperidone-treated subjects showed a significant ( p < .001 ) reduction in mean scores ( from 33.4 at baseline to 17.6 at end point ; 47.3 % reduction ) versus placebo-treated subjects ( mean baseline of 32.6 to 25.8 at end point ; 20.9 % reduction ) on the Conduct Problem subscale of the NCBRF . Between-group differences in favor of risperidone were seen as early as week 1 and were significant at all post-baseline visits . Other subscales showed significant improvement with risperidone compared with placebo .  CGI scale ratings of improvement showed highly significant gains for risperidone over placebo . A sub analysis demonstrated that the effect of risperidone was unaffected by diagnosis , presence/absence of ADHD , psychostimulant use , IQ status , and somnolence .  Risperidone produced no changes on the cognitive variables ( CPT/modified CVLT ) . The most common side effects included somnolence , headache , appetite increase , and dyspepsia . Side effects related to extrapyramidal symptoms were reported in 7 ( 13.2 % ) and 3 ( 5.3 % ) of the subjects in the risperidone and placebo groups , respectively ( p = .245 ) . CONCLUSIONS Risperidone appears to be an adequately tolerated and effective treatment in children with subaverage IQs and severe disruptive behaviors such as aggression and destructive behavior This pilot study evaluated the effects of supplementation with PUFA on blood FA composition and behavior in children with Attention-Deficit/Hyperactivity Disorder (AD/HD)-like symptoms also reporting thirst and skin problems . Fifty children were r and omized to treatment groups receiving either a PUFA supplement providing a daily dose of 480 mg DHA , 80 mg EPA , 40 mg arachidonic acid ( AA ) , 96 mg GLA , and 24 mg α-tocopheryl acetate , or an olive oil placebo for 4 mon of doubleblind parallel treatment . Supplementation with the PUFA led to a substantial increase in the proportions of EPA , DHA , and α-tocopherol in the plasma phospholipids and red blood cell ( RBC ) total lipids , but an increase was noted in the plasma phospholipid proportions of 18∶3n-3 with olive oil as well . Significant improvements in multiple but outcomes ( as rated by parents ) were noted in both groups , but a clear benefit from PUFA supplementation for all behaviors characteristic of AD/HD was not observed . For most outcomes , improvement of the PUFA group was consistently nominally better than that of the olive oil group ; but the treatment difference was significantly , by secondary intent-to-treat analysis on only 2 out of 16 outcome measures : conduct problems rated by parents ( −42.7 vs. −9.9 % , n=47 , P=0.05 ) , and attention symptoms rated by teachers ( −14.8 vs. + 3.4 % , n=47 , P=0.03 ) . PUFA supplementation led to a greater number of participants showing improvement in oppositional defiant behavior from a clinical to a non clinical range compared with olive oil supplementation ( 8 out of 12 vs. 3 out of 11 , n=33 , P=0.02 ) . Also , significant correlations were observed when comparing the magnitude of change between increasing proportions of EPA in the RBC and decreasing disruptive behavior as assessed by the Abbreviated Symptom Question naire ( ASQ ) for parents ( r=−0.38 , n=31 , P<0.05 ) , and for EPA and DHA in the RBC and the teachers ' Disruptive Behavior Disorders ( DBD ) Rating Scale for Attention ( r=−0.49 , n=24 , P<0.05 ) . Interestingly , significant correlations were observed between the magnitude of increase in α-tocopherol concentrations in the RBC and a decrease in scores for all four subscales of the teacher 's DBD ( Hyperactivity , r=−0.45 ; Attention , r=−0.60 ; Conduct , r=−0.41 ; Oppositional/Defiant Disorder , r=−0.54 ; n=24 , P<0.05 ) as well as the ASQ for teachers ( r=−0.51 , n=24 , P<0.05 ) . Thus , the results of this pilot study suggest the need for further research with both n−3 FA and vitamin E in children with behavioral disorders OBJECTIVE Multifamily psychoeducational psychotherapy ( MF-PEP ) is an efficacious treatment for children with mood disorders . Given the comorbidity between disruptive behaviors and mood disorders , this study examined associations between disruptive behaviors and impairment , impact of MF-PEP on disruptive behaviors , and whether disruptive behaviors affected treatment response of mood symptoms . METHOD Secondary analyses examined a r and omized controlled trial of MF-PEP versus waitlist control  ( N = 165 children 8 - 11 years old with mood disorders and their parents ) . Comorbid behavioral diagnoses occurred in 97 % of children . All participants continued treatment as usual . RESULTS Greater degree of disruptive behaviors was associated with worse mood symptoms and impairment . Between-group analyses examining outcome of disruptive behaviors were nonsignificant . Within-group analyses and between-group effect sizes suggested that MF-PEP was associated with decreases in attention-deficit/hyperactivity disorder ( d = 0.39 ) , oppositional defiant disorder ( d = 0.30 ) , and overall disruptive behavior symptoms ( d = 0.30 ) , but not conduct disorder symptoms . Baseline severity of disruptive behaviors did not affect treatment response of mood symptoms to MF-PEP . CONCLUSIONS MF-PEP is an effective intervention for children with mood disorders and provides some benefit for disruptive behaviors . Given that disruptive behavior severity does not affect children 's ability to experience improved mood symptoms , MF-PEP may be an important early intervention for children with comorbid mood and disruptive behavior disorders . Subsequent intervention targeting behavioral symptoms after improvement in mood may be beneficial . Studies examining treatment sequencing for children with comorbid mood and disruptive behavior disorders are needed . Clinical trial registration information-Family psychoeducation for children with mood disorders ; http:// clinical trials.gov ; NCT00050557 OBJECTIVE Youths with disruptive behavior disorders ( DBD ) ( conduct disorder and oppositional defiant disorder ) have an elevated risk for maladaptive reactive aggression . Theory suggests that this is due to an elevated sensitivity of basic threat circuitry implicated in retaliation ( amygdala/periaqueductal gray ) in youths with DBD and low levels of callous-unemotional traits and dysfunctional regulatory activity in the ventromedial prefrontal cortex in youths with DBD irrespective of callous-unemotional traits . METHOD A total of 56 youths 10 - 18 years of age ( 23 of them female ) participated in the study : 30 youths with DBD , divided by median split into groups with high and low levels of callous-unemotional traits , and 26 healthy youths . All participants completed an ultimatum game task during functional MRI . RESULTS Relative to the other groups , youths with DBD and low levels of callous-unemotional traits showed greater increases in activation of basic threat circuitry when punishing others and dysfunctional down-regulation of the ventromedial prefrontal cortex during retaliation . Relative to healthy youths , all youths with DBD showed reduced amygdala-ventromedial prefrontal cortex connectivity during high provocation . Ventromedial prefrontal cortex responsiveness and ventromedial prefrontal cortex-amygdala connectivity were related to patients ' retaliatory propensity ( behavioral responses during the task ) and parent-reported reactive aggression . CONCLUSIONS These data suggest differences in the underlying neurobiology of maladaptive reactive aggression in youths with DBD who have relatively low levels of callous-unemotional traits . Youths with DBD and low callous-unemotional traits alone showed significantly greater threat responses during retaliation relative to comparison subjects . These data also suggest that ventromedial prefrontal cortex-amygdala connectivity is critical for regulating retaliation/reactive aggression and , when dysfunctional , contributes to reactive aggression , independent of level of callous-unemotional traits This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy ( CBT ) in pediatric patients with obsessive-compulsive disorder ( OCD ) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT . Sixteen OCD out patients , 8 - 17 years of age , were treated in a 12-week open trial with manualized CBT . Target symptoms were rated at two-week intervals with the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH Global ) , the Clinical Global Impression Scale ( CGI ) , and the Hamilton Anxiety Rating Scale ( Ham-A ) . Statistical analyses showed a significant benefit for treatment . Ten patients experienced at least a 50 % reduction in symptoms on the CY-BOCS ; seven were asymptomatic on the NIMH Global . These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD . Further , the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy . These results must be considered preliminary , given the small sample size and open administration of treatment BACKGROUND Intent-to-treat analyses of the study revealed that medication management , alone or combined with intensive behavioral treatment , was superior to behavioral treatment and community care in reducing attention-deficit/hyperactivity disorder ( ADHD ) symptoms ; but only combined treatment showed consistently greater benefit than community care across other outcome domains ( disruptive and internalizing symptoms , achievement , parent-child relations , and social skills ) . We examine response patterns in subgroups defined by baseline variables ( moderators ) or variables related to treatment implementation ( mediators ) . METHODS We reconducted r and om-effects regression ( RR ) analyses , adding factors defined by moderators ( sex ,  prior medication use  ,  comorbid disruptive or anxiety disorder  , and public assistance ) and a mediator ( treatment acceptance/attendance ) . RESULTS Study outcomes ( N = 579 ) were upheld in most moderator subgroups ( boys and girls , children with and without prior medication , children with and without comorbid disruptive disorders ) . Comorbid anxiety disorder did moderate outcome ; in participants without anxiety , results paralleled intent-to-treat findings . For those with anxiety disorders , however , behavioral treatment yielded significantly better outcomes than community care ( and was no longer statistically different from medication management and combined treatment ) regarding ADHD-related and internalizing symptoms . In families receiving public assistance , medication management yielded decreased closeness in parent-child interactions , and combined treatment yielded relatively greater benefits for teacher-reported social skills . In families with high treatment acceptance/attendance , intent-to-treat results were upheld . Acceptance/attendance was particularly important for medication treatments . Finally , two thirds of children given community care received stimulants . Behavioral treatment did not significantly differ from , but medication management was superior to , this subgroup . CONCLUSIONS Exploratory analyses revealed that our study ( the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder [ MTA ] ) results were confirmed across most baseline variables and treatment acceptance/attendance . In children with ADHD plus anxiety , behavioral treatment surpassed community care and approached medication-based treatments regarding parent-reported ADHD symptoms OBJECTIVE The authors compared the effects of maintenance versus withdrawal of risperidone treatment in children and adolescents with symptoms of disruptive behavior disorder . METHOD Patients with disruptive behavior disorder ( 5 - 17 years of age and a range of intellect ) who had responded to risperidone treatment over 12 weeks were r and omly assigned to 6 months of double-blind treatment with either risperidone or placebo . The primary efficacy measure was time to symptom recurrence , defined as sustained deterioration on either the Clinical Global Impression severity rating ( /2 points ) or the conduct problem subscale of the Nisonger Child Behavior Rating Form ( /7 points ) . Secondary efficacy measures included rates of discontinuation due to symptom recurrence , disruptive behavior disorder symptoms , and general function . Safety and tolerability were also assessed . Risperidone dosage was based on weight ( patients < 50 kg : 0.25 - 0.75 mg/day ; patients /50 kg : 0.5 - 1.5 mg/day ) . RESULTS Treatment was initiated in 527 patients , with 335 r and omly assigned to a double-blind maintenance condition . Time to symptom recurrence was significantly longer in patients who continued risperidone treatment than in those switched to placebo .  Symptom recurrence in 25 % of patients occurred after 119 days with risperidone and 37 days with placebo . Secondary efficacy measures also favored risperidone over placebo .  Weight increased over the initial 12 weeks of treatment ( mean weight z score change=0.2 , SD=2.7 , N=511 ) , after which it plateaued . CONCLUSIONS This study is the first placebo-controlled maintenance versus withdrawal trial of its kind in disruptive behavior disorder and provides evidence that patients who respond to initial treatment with risperidone  would benefit from continuous treatment over the longer term A crossover ‘ placebo’-controlled , double-blind design was used to examine the effectiveness of an oligoantigenic diet in 49 children with hyperactive/disruptive behavior disorder . Effects of diet were compared with those yielded by stimulant medication ( methylpheni date ) . The study was conducted in an inpatient unit at the Department of Child and Adolescent Psychiatry , Central Institute of Mental Health , Mannheim .  Change in behavior was measured in st and ardized situations by trained raters , including behavior assessment when testing with CPT and PAT , during a free play situation , and at school . Twelve children ( 24 % ) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions . Methylpheni date used in 36 children yielded more responders ( 44 % ) than diet . The amount of positive changes in behavior in those who received both treatments was about the same . Although only effective in a minority of children , dietary treatment can not be neglected as a possible access to treating hyperactive/disruptive children and merits further investigation OBJECTIVE To review published literature regarding aripiprazole in child and adolescent psychiatry . METHOD A literature review was conducted using the medline search term : ' aripiprazole ' with limits : Human trials , English language , All Child ( aged 0 - 18 years ) . Additional articles were identified from reference information and poster presentation data . RESULTS Aripiprazole is an atypical antipsychotic which was recently approved for use in Canada , but has been available for several years in the United States . Pharmacologically , aripiprazole is a partial agonist at D(2 ) and 5-HT(1A ) receptors and an antagonist at 5-HT(2A ) receptors . R and omized controlled trial data is available showing efficacy for aripiprazole in the treatment of children and adolescents with schizophrenia , bipolar disorder and behavioural problems associated with autism . Open-label evidence is also available for use of aripiprazole in other disorders such as tic disorders , aggression and disruptive behavior disorders . Unlike some other available atypical antipsychotics , there does not appear to be any effect on QTc interval on the electrocardiogram . Adverse effects including extrapyramidal symptoms ( EPS ) , akathisia , sedation , headache , nausea were significant in clinical trials in children and adolescents . The possibility of aripiprazole causing tardive dyskinesia can not be excluded . In this population , aripiprazole appears to have minimal impact on the metabolic profile compared to most other atypical antipsychotics , with minimal changes in weight or body mass index , no significant changes in glucose or lipid metabolism , and a decrease in serum prolactin . CONCLUSION Aripiprazole may represent an important alternative for some children and adolescents who have experienced poor efficacy or significant metabolic adverse effects with their current antipsychotic treatment regimen We report the results of an open trial of trazodone in the treatment of  severe behavioral disturbances in a sample of 22 hospitalized children previously found to be unresponsive to other treatments . Response to treatment was assessed by overall clinical criteria and improvements in individual symptom dimensions during the inpatient hospitalization . Thirteen children ( 67 % ) were found to benefit from the introduction of trazodone .  Aggressive , impulsive behaviors were symptoms most frequently improved by this agent . Three of those found to be nonresponders actually worsened in symptomatology . A follow-up interview of the parents was conducted 3 - 14 months after discharge from the inpatient unit , for those children who initially responded to trazodone administration . The results of this interview suggest that the effect of trazodone was persistent for a prolonged period of time after the initial inpatient trial . Trazodone appears to be of value in the management of  severe behavioral disturbances in children . The possible mechanism of action of trazodone is discussed OBJECTIVE To determine the long-term safety and effectiveness of risperidone for severe disruptive behaviors in children . METHOD A multisite , 1-year , open-label study of patients aged 5 to 14 years with disruptive behaviors and subaverage intelligence was conducted . RESULTS Seventy-three percent of the 504 patients enrolled completed the study . The mean + /- SE dose of risperidone was 1.6 + /- 0.0 mg/day . The most common adverse events were somnolence ( 30 % ) , rhinitis ( 27 % ) , and headache ( 22 % ) . The incidence of movement disorders was low , and mean Extrapyramidal Symptom Rating Scale scores decreased during risperidone treatment . No clinical ly significant changes in mean laboratory values were noted , except for a transient increase in serum prolactin levels . Scores on the Nisonger Child Behavior Rating Form Conduct Problem Scale improved significantly as early as week 1 , and improvement was maintained throughout the trial ( p < .001 at each time point ) . Significant improvements were noted on positive social behavior and other Nisonger Child Behavior Rating Form subscales , Aberrant Behavior Checklist , Clinical Global Impressions scale , and tests of patients ' cognitive function ( each p < .001 ) . CONCLUSIONS Risperidone was well tolerated and effective in the long-term treatment of disruptive behavior disorders in children with subaverage intelligence OBJECTIVE Most children with mental health disorders do not receive timely care because of access barriers . These initial trials aim ed to determine whether distance interventions provided by nonprofessionals could significantly decrease the proportion of children diagnosed with disruptive behavior or anxiety disorders  compared with usual care . METHOD In three practical r and omized controlled trials , 243 children ( 80 with oppositional-defiant , 72 with attention-deficit/hyperactivity , and 91 with anxiety disorders ) were stratified by DSM-IV diagnoses and r and omized to receive the Strongest Families intervention ( treatment ) or usual care ( control ) . Assessment s were blindly conducted and evaluated at 120 , 240 , and 365 days after r and omization . The intervention consisted of evidence -based participant material s ( h and books and videos ) and weekly telephone coach sessions . The main outcome was mental health diagnosis change . RESULTS Intention-to-treat analysis showed that for each diagnosis significant treatment effects were found at 240 and 365 days after r and omization . Moreover , in the overall analysis significantly more children were not diagnosed as having disruptive behavior or anxiety disorders in the treatment group than the control group ( 120 days : χ(2)(1 ) = 13.05 , p < .001 , odds ratio 2.58 , 95 % confidence interval 1.54 - 4.33 ; 240 days : χ(2)(1 ) = 20.46 , p < .001 , odds ratio 3.44 , 95 % confidence interval 1.99 - 5.92 ; 365 days : χ(2)(1 ) = 13.94 , p < .001 , odds ratio 2.75 , 95 % confidence interval 1.61 - 4.71 ) . CONCLUSIONS Compared with usual care , telephone-based treatments result ed in significant diagnosis decreases among children with disruptive behavior or anxiety . These interventions hold promise to increase access to mental health services . CLINICAL TRIAL REGISTRATION INFORMATION Strongest Families : Pediatric Disruptive Behaviour Disorder , http://www . clinical trials.gov , NCT00267579 ; Strongest Families : Pediatric Attention-Deficit/Hyperactivity Disorder , http://www . clinical trials.gov , NCT00267605 ; and Strongest Families : Pediatric Anxiety , http://www . clinical trials.gov , NCT00267566 Oppositional , defiant , and disruptive behaviors are common in clinical sample s of children with tic disorders . In this study , we sought to evaluate the short-term efficacy of a structured parent training program in children with tic disorders accompanied by disruptive behavior . Children with tic disorders and at least a moderate level of disruptive behavior were r and omly assigned to a 10-session structured parent management training program or to continue treatment as usual .  Twenty-four children ( 18 boys and 6 girls ) between the ages of 6 and 12 years ( mean 8.9 ± 2.0 years ) were enrolled ; 23 subjects completed the study . At baseline , subjects showed moderate to severe levels of oppositional and defiant behavior . Twenty subjects ( 83 % ) were on stable medication . The parent-rated Disruptive Behavior Rating Scale score decreased by 51 % in the parent management training group compared with a decrease of 19 % in the treatment as usual group ( P < .05 ) . On the Improvement scale of the Clinical Global Impression , a rater masked to treatment assignment classified 7 of 11 subjects who completed parent management training as much improved or very much improved compared with 2 of 12 subjects in the treatment as usual group ( Fisher exact test , P < .05 ) . These results suggest that parent management training is helpful for short-term improvement in disruptive behavior problems in children with tic disorders . Larger r and omized clinical trials are needed . ( J Child Neurol 2006;21:650—656 ; DOI 10.2310/ 7010.2006.00159 ) OBJECTIVE The objective of this study was to investigate the long-term safety and efficacy of risperidone in disruptive behavior disorders in children with subaverage IQs . Disruptive behavior disorders were defined as oppositional defiant disorder , disruptive behavior disorder , and conduct disorder as per the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria . METHODS This was a 48-week open-label ( OL ) extension study of risperidone in 77 children diagnosed with a disruptive behavior disorder , and either borderline intellectual function or mild or moderate mental retardation who had participated in a previous 6-week , double-blind ( DB ) study and completed at least 2 weeks of DB therapy . Children , aged 5 to 12 years inclusive , who had : 1 ) a DSM-IV Axis I diagnosis of conduct disorder , oppositional defiant disorder , or disruptive behavior disorder- not otherwise specified ; 2 ) a parent-assessed rating of > or = 24 in the Conduct Problem Subscale of the Nisonger-Child Behavior Rating Form(28 ) ; 3 ) a DSM-IV Axis II diagnosis of mild or moderate mental retardation or borderline intellectual functioning with an IQ > or = 36 and < or = 84 ; and 4 ) a score of < or = 84 on the Vinel and Adaptive Behavior Scale . Participants received oral solution risperidone given at a once daily dose of between 0.02 and 0.06 mg/kg for a maximum of 48 weeks . Participants in the DB study who had been r and omized would have had a maximum of 54 weeks of risperidone therapy . Study visits were scheduled at entry , weekly for the first month , and monthly for the remaining 11 months . RESULTS Baseline scores on the conduct problem subscale at the start of the previous DB study were similar for both treatment groups : mean values of 33.5 and 33.3 were recorded for placebo- and risperidone-treated participants , respectively . At the time of the OL baseline visit , mean Conduct Problem Subscale scores were lower in those who had been treated with risperidone than in those who remained risperidone-naïve ( 17.5 and 26.1 , respectively ) . Within 1 week of receiving daily risperidone therapy ( mean daily dose : 1.38 mg ) , those participants who had been risperidone-naïve at OL entry showed a rapid improvement in the Conduct Problem Subscale score . At the week 1 assessment , the mean change from baseline for those who had been risperidone-naïve at OL entry was similar in magnitude to the change from DB baseline recorded for participants who had received risperidone in the DB study . This mean improvement was sustained in both groups throughout the remainder of the OL study . At study endpoint , those participants who had been risperidone-naïve at OL entry experienced a highly significant mean decrease from OL baseline in the mean Conduct Problem Subscale score of 10.6 + /- 2.18 . The response to risperidone in the OL trial remained stable in those participants who had been treated with risperidone in the previous DB trial ; in this group , the mean change at study endpoint from OL baseline was a nonsignificant decrease of 1.26 + /- 1.45 . At DB baseline , 68 % of participants had a Clinical Global Impression assessment rated as marked , severe , or extremely severe . By DB study endpoint , only 17 % of participants ( 15 % of whom had received placebo and 19 % of whom had been treated with risperidone in the previous study ) had this severe an assessment ; 63 % of participants had symptoms rated as either none , very mild , or mild . Similarly , highly significant decreases from baseline in the Vinel and Adaptive Behavior Scale rating of the most troublesome symptom ( often identified as either aggression ( hitting , fighting , or temper tantrums ) were observed by study endpoint after 48 weeks of risperidone therapy . For those participants who had received placebo in the previous study , a mean decrease of 47.1 + /- 4.87 mm from a DB baseline of 79.4 + /- 2.69 mm was observed . In those who had received risperidone , a mean decrease of 43.5 + /- 4.57 mm from a DB baseline of 79.3 + /- 3.66 mm was observed . Five subgroup analyses of the primary efficacy outcome were performed . These included analysis by diagnosis ( conduct disorder , oppositional defiant disorder , and disruptive behavior disorder-not otherwise specified ) , degree of mental retardation ( borderline , mild , moderate ) , and presence or absence of somnolence , attention-deficit/hyperactivity disorder , and psychostimulants . The results showed that the efficacy of risperidone was not affected by type of disorder , level of retardation , presence/absence of somnolence or attention-deficit/hyperactivity disorder , or use of psychostimulants . Adverse events  were reported for 76 participants ; none were serious and most were mild/moderate in severity . Somnolence ( 52 % ) , headache ( 38 % ) , and weight gain ( 36 % ) were the most common adverse events . The degree of sedation was mild and not associated with cognitive deterioration . In fact , for most parameters assessed on the modified California Verbal Learning Test ( a test for verbal learning and memory ) , there were statistically significant improvements relative to both OL and DB baselines in the mean scores . In addition , statistically significant improvements over baseline were also seen for some Continuous Performance Task ( which is a test for attention and impulsivity ) parameters . Overall , no deterioration of cognitive function was observed while participants were treated with risperidone . Almost half of the 8.5 kg gained was attributable to normal growth . Asymptomatic peak prolactin levels were observed within 4 weeks of beginning risperidone treatment and declined over time to within normal range . At study endpoint , mean prolactin levels were statistically significantly greater than baseline only in male participants but still < 20 ng/mL , which is within the normal range . Twenty participants experienced mild or moderate extrapyramidal symptoms , although none withdrew for this reason . CONCLUSIONS Risperidone , administered as an oral solution at a mean dose of 1.38 mg/d ( range : 0.02 - 0.06 mg/kg/d ) for 1 year , was well tolerated , safe , and showed maintenance of effect in the treatment of disruptive behavior disorders in children aged 5 to 12 years with subaverage IQs Annual screenings of preschool children at kindergarten registration identified 158 children having high levels of aggressive , hyperactive , impulsive , and inattentive behavior . These " disruptive " children were r and omly assigned to four treatment conditions lasting the kindergarten school year : no treatment , parent training only , full-day treatment classroom only , and the combination of parent training with the classroom treatment . Results showed that parent training produced no significant treatment effects , probably owing largely to poor attendance . The classroom treatment produced improvement in multiple domains : parent ratings of adaptive behavior , teacher ratings of attention , aggression , self-control , and social skills , as well as direct observations of externalizing behavior in the classroom . Neither treatment improved academic achievement skills or parent ratings of home behavior problems , nor were effects evident on any lab measures of attention , impulse control , or mother-child interactions . It is concluded that when parent training is offered at school registration to parents of disruptive children identified through a brief school registration screening , it may not be a useful approach to treating the home and community behavioral problems of such children . The kindergarten classroom intervention was far more effective in reducing the perceived behavioral problems and impaired social skills of these children . Even so , most treatment effects were specific to the school environment and did not affect achievement skills . These findings must be viewed as tentative until follow-up evaluations can be done to determine the long-term outcomes of these interventions Background Various clinical trials suggested that risperidone was beneficial in the treatment of autism spectrum disorder ( ASD ) in children and adolescents . Objective The aim of this systematic review was to determine the efficacy , acceptability and tolerability of risperidone in the treatment of children and adolescents with ASD . Data sources The data bases of Scopus , PubMed , CINAHL and Cochrane Controlled Trials Register were search ed in February 2017 . Study eligibility criteria , participants and interventions Eligible RCTs of risperidone in the treatment of child and adolescent patients with ASD . Language s were not restricted . Study appraisal and synthesis methods The full-text versions of relevant studies were thoroughly assessed and extracted . The primary efficacy of outcome was the pooled response rate and the pooled mean changed scores of the st and ardized rating scales for ASD . Results A total of 372 r and omized subjects from seven RCTs were included in this review . In acute treatment , the pooled mean change score of the Aberrant Behavior Checklist for irritability subscale ( ABC-I ) and response rate for the risperidone-treated group had a greater significance than that of the placebo-treated group . In the long-term treatment , the pooled mean change score of the CARS in the risperidone-treated group was significantly greater than that in the placebo-treated group . According to the discontinuation phase , the overall pooled relapse rate of the risperidone-treated group was significantly less than that of the placebo-treated group . The rates of pooled overall discontinuation and discontinuation due to adverse events rates were not different between the two groups in acute and long-term treatments . Limitations A small study was included in the current review . Conclusion In relation to the current systematic review , risperidone is efficacious in the treatment of symptoms in children and adolescents with ASD . Although its acceptability is comparable to placebo , treatment with risperidone is well tolerated in children and adolescents with ASD OBJECTIVE Few studies exist that examine continuities between child and adult psychopathology in unselected sample s. This study prospect ively examined the adult outcomes of psychopathology in an epidemiological sample of children and adolescents across a 14-year period . METHOD In 1983 ,  parent ratings of behavioral and emotional problems were obtained for 1,578 children and adolescents aged 4 through 16 years from the Dutch general population . At follow-up , 14 years later , subjects were reassessed with a st and ardized DSM-IV interview . RESULTS High levels of childhood problems predicted an approximate 2- to 6-fold increased risk for adulthood DSM-IV diagnoses . The associations between specific childhood problems and adulthood diagnoses were complex . Social Problems in girls predicted later DSM-IV disorder . Rule-breaking behavior in boys predicted both mood disorders and disruptive disorders in adulthood . CONCLUSIONS High levels of childhood behavioral and emotional problems are related to DSM-IV diagnoses in adulthood . The strongest predictor of disorders in adulthood was childhood rule-breaking behavior . Attention Problems did not predict any of the DSM-IV categories when adjusted for the associations with other Child Behavior Checklist scales This study examines the impact of a brief booster treatment administered 3 years after the delivery of an acute treatment in a group ( n = 118 ) of clinical ly referred boys and girls ( ages 6 to 11 ) originally diagnosed with Oppositional Defiant Disorder ( ODD ) or Conduct Disorder ( CD ) . At the conclusion of the acute treatment and three-year follow-up period ( i.e. , study month 42 ) , the sample was re-r and omized into Booster treatment or Enhanced Usual Care and then assessed at four later timepoints ( i.e. , post-booster , and 6- , 12- and 24-month booster follow-up ) . Booster treatment was directed towards addressing individualized problems and some unique developmental issues of adolescence based on the same original protocol content and treatment setting , whereas the Enhanced Usual Care condition involved providing clinical recommendations based on the assessment and an outside referral for services . HLM analyses identified no significant group differences and few time effects across child , parent , and teacher reports on a broad range of child functioning and impairment outcomes . Analyses examining the role of putative moderators or predictors ( e.g. , severity of externalizing behavior , dose of treatment ) were likewise non-significant . We discuss the nature and implication s of these novel findings regarding the role and timing of booster treatment to address the continuity of DBD over time Objective To present the design , methods , and rationale of the Child/Adolescent Anxiety Multimodal Study ( CAMS ) , a recently completed federally-funded , multi-site , r and omized placebo-controlled trial that examined the relative efficacy of cognitive-behavior therapy ( CBT ) , sertraline ( SRT ) , and their combination ( COMB ) against pill placebo ( PBO ) for the treatment of separation anxiety disorder ( SAD ) , generalized anxiety disorder ( GAD ) and social phobia ( SoP ) in children and adolescents . Methods Following a brief review of the acute outcomes of the CAMS trial , as well as the psychosocial and pharmacologic treatment literature for pediatric anxiety disorders , the design and methods of the CAMS trial are described . Results CAMS was a six-year , six-site , r and omized controlled trial . Four hundred eighty-eight ( N = 488 ) children and adolescents ( ages 7 - 17 years ) with DSM-IV-TR diagnoses of SAD , GAD , or SoP were r and omly assigned to one of four treatment conditions : CBT , SRT , COMB , or PBO . Assessment s of anxiety symptoms , safety , and functional outcomes , as well as putative mediators and moderators of treatment response were completed in a multi-measure , multi-informant fashion . Manual-based therapies , trained clinicians and independent evaluators were used to ensure treatment and assessment fidelity . A multi-layered administrative structure with representation from all sites facilitated cross-site coordination of the entire trial , study protocol s and quality assurance . Conclusions CAMS offers a model for clinical trials methods applicable to psychosocial and psychopharmacological comparative treatment trials by using state-of-the-art methods and rigorous cross-site quality controls . CAMS also provided a large-scale examination of the relative and combined efficacy and safety of the best evidence d-based psychosocial ( CBT ) and pharmacologic ( SSRI ) treatments to date for the most commonly occurring pediatric anxiety disorders . Primary and secondary results of CAMS will hold important implication s for informing practice -relevant decisions regarding the initial treatment of youth with anxiety disorders . Trial registration Clinical Trials.gov NCT00052078 IMPORTANCE Disruptive behavior disorders , such as attention-deficient/hyperactivity disorder and oppositional defiant disorder , are common and stable throughout childhood . These disorders cause long-term morbidity but benefit from early intervention . While symptoms are often evident before preschool , few children receive appropriate treatment during this period . Group parent training , such as the Incredible Years program , has been shown to be effective in improving parenting strategies and reducing children 's disruptive behaviors . Because they already monitor young children 's behavior and development , primary care pediatricians are in a good position to intervene early when indicated . OBJECTIVE To investigate the feasibility and effectiveness of parent-training groups delivered to parents of toddlers in pediatric primary care setting s. DESIGN , SETTING , AND PARTICIPANTS This r and omized clinical trial was conducted at 11 diverse pediatric practice s in the Greater Boston area . A total of 273 parents of children between 2 and 4 years old who acknowledged disruptive behaviors on a 20-item checklist were included . INTERVENTION A 10-week Incredible Years parent-training group co-led by a research clinician and a pediatric staff member . MAIN OUTCOMES AND MEASURES Self-reports and structured videotaped observations of parent and child behaviors conducted prior to , immediately after , and 12 months after the intervention . RESULTS A total of 150 parents were r and omly assigned to the intervention or the waiting-list group . An additional 123 parents were assigned to receive intervention without a r and omly selected comparison group . Compared with the waiting-list group , greater improvement was observed in both intervention groups ( P < .05 ) . No differences were observed between the r and omized and the nonr and omized intervention groups . CONCLUSIONS AND RELEVANCE Self-reports and structured observations provided evidence of improvements in parenting practice s and child disruptive behaviors that were attributable to participation in the Incredible Years groups . This study demonstrated the feasibility and effectiveness of parent-training groups conducted in pediatric office setting s to reduce disruptive behavior in toddlers . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00402857 IMPORTANCE Disruptive behavior is common in children with autism spectrum disorder . Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale r and omized trials . OBJECTIVE To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior . DESIGN , SETTING , AND PARTICIPANTS This 24-week r and omized trial compared  parent training ( n = 89 ) to parent education ( n = 91 ) at 6 centers ( Emory University , Indiana University , Ohio State University , University of Pittsburgh , University of Rochester , Yale University ) . We screened 267 children ; 180 children ( aged 3 - 7 years ) with autism spectrum disorder and disruptive behaviors were r and omly assigned ( 86 % white , 88 % male ) between September 2010 and February 2014 .  INTERVENTIONS Parent training ( 11 core , 2 optional sessions ; 2 telephone boosters ; 2 home visits ) provided specific strategies to manage disruptive behavior . Parent education ( 12 core sessions , 1 home visit ) provided information about autism but no behavior management strategies . MAIN OUTCOMES AND MEASURES Parents rated disruptive behavior and noncompliance on co- primary outcomes : the Aberrant Behavior Checklist-Irritability subscale ( range , 0 - 45 ) and the Home Situations Question naire-Autism Spectrum Disorder ( range , 0 - 9 ) . On both measures , higher scores indicate greater severity and a 25 % reduction indicates clinical improvement . A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression ( range , 1 - 7 ) , a secondary outcome , with a positive response less than 3 . RESULTS At week 24 , the Aberrant Behavior Checklist-Irritability subscale declined 47.7 % in parent training ( from 23.7 to 12.4 ) compared with 31.8 % for parent education ( 23.9 to 16.3 ) ( treatment effect , -3.9 ; 95 % CI , -6.2 to -1.7 ; P < .001 , st and ardized effect size = 0.62 ) . The Home Situations Question naire-Autism Spectrum Disorder declined 55 % ( from 4.0 to 1.8 ) compared with 34.2 % in parent education ( 3.8 to 2.5 ) ( treatment effect , -0.7 ; 95 % CI , -1.1 to -0.3 ; P < .001 , st and ardized effect size = 0.45 ) . Neither measure met the prespecified minimal clinical ly important difference . The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5 % for parent training vs 39.6 % for parent education ( P < .001 ) . CONCLUSIONS AND RELEVANCE For children with autism spectrum disorder , a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes , although the clinical significance of the improvement is unclear . The rate of positive response judged by a blinded clinician was greater for parent training vs parent education . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01233414 Families with socioeconomically disadvantaged and ethnic minority background s are often hard to reach for the prevention and treatment of  disruptive child behavior problems . We examined whether the Incredible Years parenting intervention can successfully reach and benefit families with socioeconomic disadvantaged and ethnic minority background s in the Netherl and s. One hundred fifty-four families from a wide range of socioeconomic and ethnic background s were recruited in an outpatient clinic for child and adolescent psychiatry and in elementary schools serving deprived neighborhoods . Families were r and omly assigned to the BASIC Incredible Years parenting intervention or a waiting list control condition .  Children were 3–8 years old ( M = 5.59 , SD = 1.35 ; 62 % boys , 66 % ethnic minorities ) and 65 % of the children met Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . , text rev . ) criteria for oppositional defiant disorder , conduct disorder , and /or attention-deficit hyperactivity disorder . Incredible Years reduced parent-reported disruptive child behavior and teacher-reported hyperactive and inattentive child behavior and increased parent-reported use of praise and incentives and reduced harsh and inconsistent discipline . Incredible Years did not affect parent-reported hyperactive and inattentive child behavior ; teacher-reported child conduct problems ; and parent-reported use of appropriate discipline techniques , clear expectations , physical punishment , and parenting stress . Of importance , the effectiveness of Incredible Years did not differ across families with different socioeconomic and ethnic background s. Effects were maintained at 3-month follow-up . This study shows that socioeconomically disadvantaged and ethnic minority families in disadvantaged neighborhoods can be engaged in and benefit from parenting interventions to reduce disruptive child behavior The purpose s of this study were to examine the type of response to different situations displayed by children with or without conduct disorders and to assess the efficacy of the social skills training program herein proposed for modifying styles of interpersonal relationship in children . The sample included 315 children , 8 to 12 years of age . Those exhibiting conduct problems were 164 boys , and those having no conduct problems were 151 boys . All participants shared a low socioeconomic and cultural status and attended schools located in poor districts of Mendoza City in Argentina . Analysis showed that the groups trained in social skills improved in social interaction by reducing disruptive behaviors , whereas the groups without social skills training showed no behavioral changes . These data were confirmed by the teachers ' assessment s. These results suggest social skills training seems an efficient therapeutic approach to the attenuation of behavior disorders of boys OBJECTIVE The authors sought to replicate open-label findings showing that specific criteria for explosive temper and mood lability identify disruptive youth who improve while receiving the anticonvulsant divalproex sodium . METHOD Twenty outpatient children and adolescents ( ages 10 - 18 ) with a disruptive behavior disorder ( oppositional defiant disorder or conduct disorder ) met the specific criteria for explosive temper and mood lability . They received 6 weeks of divalproex treatment and 6 weeks of placebo by r and om assignment . Independent evaluators blind to group assignment assessed response at the end of each phase . RESULTS At the end of phase 1 , eight of 10 subjects had responded to divalproex ; zero of 10 had responded to placebo . Of the 15 subjects who completed both phases , 12 has superior response taking divalproex . CONCLUSIONS This preliminary study replicates open-label findings showing that divalproex is an efficacious treatment for explosive temper and mood lability in disruptive children and adolescents Objective . To investigate the efficacy and safety of risperidone for the treatment of disruptive behavioral symptoms in children with autism and other pervasive developmental disorders ( PDD ) . Methods . In this 8-week , r and omized , double-blind , placebo-controlled trial , risperidone/placebo solution ( 0.01–0.06 mg/kg/day ) was administered to 79 children who were aged 5 to 12 years and had PDD . Behavioral symptoms were assessed using the Aberrant Behavior Checklist ( ABC ) , Nisonger Child Behavior Rating Form , and Clinical Global Impression-Change . Safety assessment s included vital signs , electrocardiogram , extrapyramidal symptoms , adverse events , and laboratory tests . Results . Subjects who were taking risperidone ( mean dosage : 0.04 mg/kg/day ; 1.17 mg/day ) experienced a significantly greater mean decrease on the irritability subscale of the ABC ( primary endpoint ) compared with those who were taking placebo . By study endpoint , risperidone-treated subjects exhibited a 64 % improvement over baseline in the irritability score almost double that of placebo-treated subjects ( 31 % ) . Risperidone-treated subjects also exhibited significantly greater decreases on the other 4 subscales of the ABC ; on the conduct problem , insecure/anxious , hyperactive , and overly sensitive subscales of the Nisonger Child Behavior Rating Form ( parent version ) ; and on the Visual Analog Scale of the most troublesome symptom . More risperidone-treated subjects ( 87 % ) showed global improvement in their condition compared with the placebo group ( 40 % ) . Somnolence , the most frequently reported adverse event , was noted in 72.5 % versus 7.7 % of subjects ( risperidone vs placebo ) and seemed manageable with dose/dose-schedule modification . Risperidone-treated subjects experienced statistically significantly greater increases in weight ( 2.7 vs 1.0 kg ) , pulse rate , and systolic blood pressure . Extrapyramidal symptoms scores were comparable between groups . Conclusions . Risperidone was well tolerated and efficacious in treating behavioral symptoms associated with PDD in children The Good Behavior Game ( GBG ) , a method of teacher classroom behavior management , was tested in first- and second- grade classrooms in 19 Baltimore City Public Schools beginning in the 1985–1986 school year . The intervention was directed at the classroom as a whole to socialize children to the student role and reduce aggressive , disruptive behaviors , confirmed antecedents of a profile of externalizing problem outcomes . This article reports on the GBG impact on the courses and interrelationships among aggressive , disruptive behavior through middle school , risky sexual behaviors , and drug abuse and dependence disorders through ages 19–21 . In five poor to lower-middle class , mainly African American urban areas , classrooms within matched schools were assigned r and omly to either the GBG intervention or the control condition . Balanced assignment of children to classrooms was made , and teachers were r and omly assigned to intervention or control . Analyses involved multilevel growth mixture modeling . By young adulthood , significant GBG impact was found in terms of reduced high-risk sexual behaviors and drug abuse and dependence disorders among males who in first grade and through middle school were more aggressive , disruptive . A replication with the next cohort of first- grade children with the same teachers occurred during the following school year , but with minimal teacher mentoring and monitoring . Findings were not significant but generally in the predicted direction . A universal classroom-based prevention intervention in first- and second- grade classrooms can reduce drug abuse and dependence disorders and risky sexual behaviors A positive influence of magnesium in the prevention and treatment of  hyperactivity in children is more and more frequently raised in the literature . The aim of our work was to estimate  magnesium contents in children with attention deficit hyperactivity disorder , ( ADHD ) . The investigations comprised 116 children ( 94 boys and 20 girls ) , aged 9 - 12 years , with recognized ADHD . In 68 out of 116 patients examined ADHD occurred with other coexisting disorders specific to the developmental age and in the remaining 48 patients it occurred together with disruptive behaviour . Magnesium levels have been determined in blood serum , red blood cells and in hair with the aid of atomic absorption spectroscopy . Magnesium deficiency was found in 95 per cent of those examined , most frequently in hair ( 77.6 per cent ) , in red blood cells ( 58.6 per cent ) and in blood serum ( 33.6 per cent ) of children with ADHD . The conclusion from the investigations is that magnesium deficiency in children with ADHD occurs more frequently than in healthy children . Analysis of the material indicated the correlation between levels of magnesium and the quotient of development to freedom from distractibility Children of parents with substance use disorders ( SUDs ) have been shown to demonstrate an increased risk for cigarette smoking in adolescence . In this prospect i ve study , we hypothesized that adolescent cigarette smoking risk would be accounted for by childhood disruptive behavior disorders and parent cigarette smoking . Preadolescent children ( ages 10 - 12 years ) of fathers with SUD considered at high average risk ( HAR ; n=274 ) and children of fathers without SUD or major psychopathology considered at low average risk ( LAR ; n=298 ) participated in structured interviews to determine mental disorder diagnoses and substance use history . Both parents were assessed . The age of onset of daily tobacco use was determined in three follow-up assessment s conducted through late adolescence . Conduct disorder ( CD ) and parental smoking predicted earlier daily cigarette smoking , and mediated the relationship between risk status and offspring daily cigarette smoking . Through the identification of childhood characteristics predicting daily cigarette smoking in adolescence , these results may facilitate targeting of early childhood preventive interventions To eluci date processes underlying therapeutic change in a large-scale r and omized clinical trial , we examined whether alterations in self-reported parenting practice s were associated with the effects of behavioral , medication , or combination treatments on teacher-reported outcomes ( disruptive behavior , social skills , internalizing symptoms ) in children with attention-deficit hyperactivity disorder ( ADHD ) . Participants were 579 children with Combined-type ADHD , aged 7–9.9 years , in the Multimodal Treatment Study of Children with ADHD ( MTA ) . We uncovered 2 second-order factors of parenting practice s , entitled Positive Involvement and Negative/Ineffective Discipline . Although Positive Involvement was not associated with amelioration of the school-based outcome measures , reductions in Negative/Ineffective Discipline mediated improvement in children 's social skills at school . For families showing the greatest reductions in Negative/Ineffective Discipline , effects of combined medication plus behavioral treatment were pronounced in relation to regular community care . Furthermore , only in combination treatment ( and not in behavioral treatment alone ) was decreased Negative/Ineffective Discipline associated with reduction in children 's disruptive behavior at school . Here , children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized . Overall , the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practice s at home ; we discuss problems in interpreting the temporal sequencing of such process- outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting This article presents results of a r and omized controlled trial examining the efficacy of Parent – Child Interaction Therapy ( PCIT ) for treating  disruptive behaviors of young children ( ages 3 to 6 ) with mental retardation ( MR ) and comorbid oppositional defiant disorder . Thirty families were r and omly assigned to an immediate treatment ( IT ) or waitlist ( WL ) control group . Results indicated that IT mothers interacted more positively with their children after treatment than WL mothers , and their children were more compliant after treatment . On parent-report measures , IT mothers reported fewer disruptive behaviors at home and lower parenting stress related to difficult child behavior than WL mothers after treatment . Whether evidence -based treatments for disruptive behavior require modification before application to children with MR is discussed BACKGROUND Research has begun to eluci date the optimal pharmacological treatments for pediatric-onset bipolar patients , but few studies have examined the role of psychosocial interventions as adjuncts to pharmacotherapy in maintenance treatment . This article describes an adjunctive family-focused psychoeducational treatment for bipolar adolescents ( FFT-A ) . The adult version of FFT has been shown to be effective in forestalling relapses in two r and omized clinical trials involving bipolar adults . METHODS FFT-A is administered to adolescents who have had an exacerbation of manic , depressed , or mixed symptoms within the last 3 months . It is given in 21 outpatient sessions of psychoeducation , communication enhancement training , and problem solving skills training . We describe modifications to the adult FFT model to address the developmental issues and unique clinical presentations of pediatric-onset patients . RESULTS An open treatment trial involving 20 bipolar adolescents ( 11 boys , 9 girls ; mean age 14.8+/-1.6 ) found that the combination of FFT-A and mood stabilizing medications was associated with improvements in depression symptoms , mania symptoms , and behavior problems over 1 year . LIMITATIONS These early results are based on a small-scale open trial . CONCLUSIONS Results from an ongoing r and omized controlled trial will clarify whether combining FFT-A with pharmacotherapy improves the 2-year course of adolescent bipolar disorder . If the results are positive , then a structured manual-based psychosocial approach will be available for clinicians who treat adolescent bipolar patients in the community OBJECTIVE Although combination pharmacotherapy is common in child and adolescent psychiatry , there has been little research evaluating it . The value of adding risperidone to concurrent psychostimulant and parent training ( PT ) in behavior management for children with severe aggression was tested . METHOD One hundred sixty-eight children 6 to 12 years old ( mean age 8.89 ± 2.01 years ) with severe physical aggression were r and omized to a 9-week trial of PT , stimulant ( STIM ) , and placebo ( Basic treatment ; n = 84 ) or PT , STIM , and risperidone ( Augmented treatment ; n = 84 ) . All had diagnoses of attention-deficit/hyperactivity disorder and oppositional-defiant disorder ( n = 124 ) or conduct disorder ( n = 44 ) . Children received psychostimulant ( usually Osmotic Release Oral System methylpheni date ) for 3 weeks , titrated for optimal effect , while parents received PT . If there was room for improvement at the end of week 3 , placebo or risperidone was added . Assessment s included parent ratings on the Nisonger Child Behavior Rating Form ( Disruptive-Total subscale was the primary outcome ) and Antisocial Behavior Scale ; blinded clinicians rated change on the Clinical Global Impressions scale . RESULTS Compared with Basic treatment ( PT + STIM [ 44.8 ± 14.6 mg/day ] + placebo [ 1.88 mg/day ± 0.72 ] ) , Augmented treatment ( PT + STIM [ 46.1 ± 16.8 mg/day ] + risperidone [ 1.65 mg/day ± 0.75 ] ) showed statistically significant improvement on the Nisonger Child Behavior Rating Form Disruptive-Total subscale ( treatment-by-time interaction , p = .0016 ) , the Nisonger Child Behavior Rating Form Social Competence subscale ( p = .0049 ) , and Antisocial Behavior Scale Reactive Aggression subscale ( p = .01 ) . Clinical Global Impressions scores were substantially improved for the 2 groups but did not discriminate between treatments ( Clinical Global Impressions-Improvement score ≤2 , 70 % for Basic treatment versus 79 % for Augmented treatment ) . Prolactin elevations and gastrointestinal upset occurred more with Augmented treatment ; other adverse events differed modestly from Basic treatment ; weight gain in the Augmented treatment group was minor . CONCLUSIONS Risperidone provided moderate but variable improvement in aggressive and other seriously disruptive child behaviors when added to PT and optimized stimulant treatment . Clinical trial registration information-Treatment of Severe Childhood Aggression ( The TOSCA Study ) , URL : http:// clinical trials.gov , unique identifier : NCT00796302 OBJECTIVES : The objective of this study was to examine factors that are associated with aggression that is responsive versus refractory to individualized optimization of stimulant monotherapy among children with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS : Children who were aged 6 to 13 years and had ADHD , either oppositional defiant disorder or conduct disorder , significant aggressive behavior , and a history of insufficient response to stimulants completed an open stimulant monotherapy optimization protocol  . Stimulant titration with weekly assessment s of behavior and tolerability identified an optimal regimen for each child . Families also received behavioral therapy . Parents completed the Retrospective-Modified Overt Aggression Scale ( R-MOAS ) at each visit . Children were classified as having stimulant-refractory aggression on the basis of R-MOAS ratings and clinician judgment . Differences that pertained to treatment , demographic , and psychopathology between groups with stimulant monotherapy – responsive and –refractory aggression were evaluated . RESULTS : Aggression among 32 ( 49.3 % ) of 65 children was reduced sufficiently after stimulant dosage adjustment and behavioral therapy to preclude adjunctive medication . Those who responded to stimulant monotherapy were more likely to benefit from the protocol 's methylpheni date preparation ( once-daily , triphasic release ) , showed a trend for lower average dosages , and received fewer  behavioral therapy  sessions than did children with stimulant-refractory aggression . Boys , especially those with higher ratings of baseline aggression and of depressive and manic symptoms , more often exhibited stimulant-refractory aggression . CONCLUSIONS : Among children whose aggressive behavior develops in the context of ADHD and of oppositional defiant disorder or conduct disorder , and who had insufficient response to previous stimulant treatment in routine clinical care , systematic , well-monitored titration of stimulant monotherapy often culminates in reduced aggression that averts the need for additional agents
Results There is some evidence of the effectiveness of medication in treating DBDs , with positive outcomes for lithium and risperidone in particular .
Pharmacotherapy also demonstrated some efficacy in reducing symptoms of aggression .
Medication was relatively well-tolerated , as indicated by equivalent dropout rates in medication and comparison groups .
Rationale Pharmacotherapy is frequently considered in the treatment of  disruptive behavior disorders ( DBDs ) in children and adolescents .
There are , however , no systematic review s of this literature .
Objectives The aim of this work is to determine whether medication is effective in treating pediatric disruptive behavior disorders and related problems of impulse control , as well as to examine differences in the treatment response and tolerability of different medication classes and agents .