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In their recently published trial, Joseph C. Blader, Ph.D., and colleagues found that among children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and aggressive behavior, systematically optimizing methylphenidate (MPH) dosages was effective in significantly reducing aggression.
Although this sample of 6- to 13-yearolds had previous insufficient stimulant response, such individualized attention to titration averted the need in nearly half of the patients for additional treatment agents. Blader is Assistant Professor of Psychiatry at Stony Brook University School of Medicine, State University of New York.
The authors cite an increasing trend of using adjunctive antipsychotic agents to manage disruptive behaviors in children with ADHD (Olfson M et al., 2006), despite the significant risk of adverse effects. Although practice guidelines recommend antipsychotic use only when aggression is persistent, the authors write that several factors "hasten the initiation of antipsychotic treatment and the premature conclusion or avoidance of stimulant monotherapy."
First, it is unclear under what circumstances a clinician should consider aggressive behavior as refractory to stimulant monotherapy. Second, it is not known how often stimulant monotherapy actually leads to remission of aggressive behavior. And finally, impulsive aggressive children often display the irritability and poor anger control that are associated with the development of mood …