Externalizing Behavior Disorders. Jess P. Shatkin, MD, MPH Director of Education and Training NYU Child Study Center New York University School of Medicine.
Jess P. Shatkin, MD, MPH
Director of Education and Training
NYU Child Study Center
New York University School of Medicine
*at least one criterion before age 10 y/o
*usually male; frequently aggressive
*disturbed peer relations
*often suffered ODD as a child; may have concurrent ADHD
*most likely to have persistent CD and to develop APD
*absence of criteria prior to age 10 y/o
*less likely to display aggressive behaviors
*tend to have normative peer relations
*less likely to suffer persistent CD and to develop APD
*still more males:females, but a lower ratio
*44 – 88% at 3 – 4 years post initial diagnosis
Rejection by normal peers & academic difficulties
Poor parental monitoring & discipline
Commit-ment to deviant peer groups
One recent study challenged 25 children w/ADHD, 7-12 years, who had persistent aggression with Risperidone augmentation to their stimulant.
They were treated for 4 weeks, randomized and double-blinded, to placebo or medication. The primary efficacy measure was change from baseline in the Children's Aggression Scale-Parent (CAS-P) and -Teacher (CAS-T) total scores.
The mean risperidone dose at endpoint was 1.08 mg/day. For the CAS-P total score, a significant difference was found with 100% of risperidone subjects improving by more than 30% from baseline to endpoint, whereas only 77% of the placebo group reported a similar response. No differences were found on the CAS-T total score. Rates of adverse events did not differ significantly between groups.
Flexible dose pharmacokinetic study of aripiprazole of 12 children (6-12 years) and 11 adolescents (13-17 years) with Conduct Disorder and a score of 2-3 on the Rating of Aggression Against People and/or Property (RAAPP) scale
Open label, 15-day, 3 site trial with optional 36 month extension
Dose: <25 kg = 2 mg/day; 25 – 50 kg = 5 mg/day; >50 – 70 kg = 10 mg/day; >70 kg = 15 mg/day
Due to vomiting and sedation, revised to 1 mg, 2 mg, 5 mg, and 10 mg/day
Both children and adolescents demonstrated improvements in RAAPP scores and CGI scores
Adverse events similar to those in adults
Findling et al, 2009