Dezember 20, 2013
COLUMBUS, Ohio -- December 20, 2013 -- Prescribingboth a stimulantand an antipsychoticdrugtochildrenwithphysicalaggressionandattention-deficit/hyperactivitydisorder (ADHD), alongwithteachingparentstousebehaviourmanagementtechniques, reduces aggressive andseriousbehaviouralproblems in thechildren, accordingto a studypublished in theJournal ofthe American Academy of Child andAdolescentPsychiatry.
“Combinationpharmacotherapyisbecomingcommon in childandadolescentpsychiatry, but therehasbeenlittleresearchevaluatingit,” saidfirstauthor Michael Aman, Ohio State University Wexner Medical Center, Columbus, Ohio. “Ourfindingsmaybeconsideredsomewhatcontroversialbecausetheyappeartosupporttheuseof 2 drugsover 2 fortreatingchildrenwithaggressionanddisruptivebehaviourwhenthings do not seemtobegoingwell. Manypractitionershavebeentaughtto ‘keepthings simple andsafe’ in theirmedicaltraining. In general, thisisgoodadvice.”
The Treatment ofSevereChildhood Aggression (TOSCA) studyincluded 168 childrenaged 6 to 12 yearswhohadbeendiagnosedwith ADHD anddisplayedsignificantphysicalaggression. All studyparticipantsreceivedosmoticcontrolled-release oral deliverysystem (OROS) methylphenidateandtheirparentsreceivedbehaviouralparenttrainingfor 9 weeks. The researcherscalledthistreatmentcombination “basic” becausebothareevidence-basedandhavebeenshowntobehelpfulforimprovingboth ADHD andaggression.
Researchers wantedtoseeiftheycouldexpandoraugmentthistreatmentbyadding a secondmedication. Ifthere was roomforimprovement at theendofthethirdweek, a placebo was addedforthe “basicgroup,” whilerisperidone was addedforparticipants in the “augmentedgroup.”
Comparedwiththe “basicgroup,” the “augmentedgroup” whoreceivedthestimulantdrugandparenttraining plus risperidoneshowedsignificantimprovement (on averagewithmoderatelybetterbehaviour) on theNisonger Child Behavior Rating Form (NCBRF) Disruptive-Total Scale, the NCBRF Social Competence subscale, andtheReactive Aggression partoftheAntisocialBehaviorScale.
Whilethereisalwayssomeriskwiththeadditionof a seconddrugtothetreatmentpackage, the 2 drugsseemedtoneutralisesomeofeachother’s potential sideeffects. Forinstance, children in theaugmentedgroupdid not seemtohaveasmuchtroublefallingasleep, oncetherisperidone was added, said Aman.
“Weconductedthisstudybecauseweviewedthecombinationof ADHD andsignificantphysicalaggression -- especiallytheaggression -- as a serioussituation,” he said. “Itis not uncommontousemorethanonemedicineforotherserioussituations, such aswhentreatingcancerorepilepsyforinstance. Althoughdoctorshaveoftenusedstimulantsandantipsychoticstogether in recentyears, wedid not havegoodevidenceuntilnowthattheywouldworkmoreeffectivelywhencarefullystagedandgiventogether.”
SOURCE: Ohio State University Wexner Medical Center