It is not uncommon for some children who have ADHD to exhibit aggressive behaviors, especially if they have co-morbid disorders including oppositional defiant disorder or conduct disorder. Parents may worry what can be done to decrease aggression as this behavior can drastically affect every aspect of their child’s life from school performance to the ability to form relationships with other people. One common remedy suggested by many medical professionals is to add an antipsychotic drug to stimulant medications in order to help with decreasing aggressive outbursts. However, a new study about to be published in the October issue of Pediatrics suggests that the use of antipsychotic medication to curb aggression in ADHD children may be unnecessary.
This study, reported on the Stony Brook University Medical Center website, was led by Joseph Blader, Ph.D., Assistant Professor of Psychiatry Behavioral Science. Blader and colleagues took a look at 65 children between the ages of 6 and 13 who were diagnosed with ADHD and either oppositional defiant disorder or conduct disorder. Standard ADHD medication treatment previously given to these children did not decrease their aggressive behavior. But when the researchers adjusted the dosage of their stimulant medication and provided behavioral therapy, they were able to significantly reduce the aggressive behaviors in almost half of their study subjects.
This study seems to send a message to parents to "hang in there" and try to find the optimum dosage of ADHD medication to make a change in their child’s behavior - even for aggressive behaviors. Dr. Blader has been quoted as saying, "The results of our research strongly suggest that more intensive and methodical approaches to prescribing stimulants may reduce the need to resort to antipsychotic medications to control severe aggression among children with ADHD." One of the major concerns of using anti-psychotic medications is the greater risk of adverse effects. Why resort to such a strong medication if it is not needed?
The other treatment component of this study was that the children and their parents had weekly behavioral therapy sessions. Parents were taught how to provide positive reinforcement by emphasizing the times when their child was able to show self-control and manage their frustrations in an acceptable way. Parents were also taught how to set limits for problem behaviors. In many ways this reinforces the proposal that a combination of medication and behavioral treatment may be the best way to tackle ADHD symptoms and problem behaviors.
In 2008, we shared a news story about a study which showed that antipsychotics don’t stop aggressive outbursts. In this study, British researchers found that placebos were just as effective as drugs such as Haldol and Risperdal in decreasing aggressive behaviors in adult subjects with special needs. This new study reinforces the conclusions that antipsychotics may not always be the answer for treating aggressive behaviors.
Another new study is being proposed to evaluate treatment options for those children who continued to demonstrate aggressive behavior even after ADHD medication is tweaked for the most therapeutic dosage. This research will be of great value to all those parents who remain frustrated by their child’s lack of behavioral progress in decreasing aggressive behaviors.
We would like to hear from our parents now. What do you make of these studies? Does your child have aggressive behaviors? What methods have you used to decrease these sorts of behaviors? What has worked the best? We will be continuing to talk about this topic of aggression in further posts. Stay tuned for more information, resources, and support for dealing with aggressive behavior.