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Aggressive Kids With ADHD May Not Need Antipsychotic Meds
Date:9/17/2010

sessments, the researchers fine-tuned the dose until the child's symptoms were well-controlled and he or she could tolerate any side effects (mainly insomnia and loss of appetite). If Concerta wasn't the right choice, a child was switched to either biphasic methylphenidate (Metadate) or biphasic mixed amphetamine salt medication (Adderall XR).

Children and their parents also had weekly behavioral therapy sessions, during which parents were encouraged to "emphasize the times when their children were able to show self-control and manage their frustrations better," Blader said. "The goal was to help parents develop rewards and incentives, while at the same time, set limits around some of the problem behaviors."

At the end of the lead-in phase, which lasted an average of five weeks, 32 of the children showed significant reductions in their aggressive behavior.

"I was very surprised by how many of the kids we couldn't randomize [to an antipsychotic medication] because their aggression went away" as doctors adjusted their type or level of stimulant drug, said Blader.

"This is an important message about hanging in there with a medication," noted Dr. Chris Varley, a child psychiatrist at Seattle Children's Hospital. He said in the last decade, there's been a dramatic increase in the use of antipsychotic medications to reduce disruptive behavior in children, and in many cases the drugs are not necessary.

"Sometimes you do need to use these medications, but in this day and age, the trigger may be pulled too quickly," said Varney, who is professor of child and adolescent psychiatry at the University of Washington School of Medicine.

Blader said the advice for children and their parents is to not get discouraged if the first ADHD drug and dosage doesn't work.

"Just like with asthma or many other health problems, it's often a bit of an exercise to find what does the trick," he said.

The researchers received funding from the U.S.
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