Externalizing Behavior Disorders. Jess P. Shatkin, MD, MPH Director of Education and Training NYU Child Study Center New York University School of Medicine.
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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