Risperidone added to parent training and stimulant medication: effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression.

Autor:	Gadow KD; Stony Brook University, Stony Brook, NY. Electronic address: kenneth.gadow@stonybrook.edu., Arnold LE; Ohio State University, Columbus, OH., Molina BS; University of Pittsburgh School of Medicine., Findling RL; Johns Hopkins University and the Kennedy Krieger Institute, Baltimore., Bukstein OG; University of Texas-Houston Medical School., Brown NV; Ohio State University, Columbus, OH., McNamara NK; Case Western Reserve University, Cleveland., Rundberg-Rivera EV; Stony Brook University, Stony Brook, NY., Li X; Ohio State University, Columbus, OH., Kipp HL; University of Pittsburgh School of Medicine., Schneider J; Stony Brook University, Stony Brook, NY., Farmer CA; Ohio State University, Columbus, OH; National Institute of Mental Health., Baker JL; Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center., Sprafkin J; Stony Brook University, Stony Brook, NY., Rice RR Jr; Ohio State University, Columbus, OH., Bangalore SS; University of Pittsburgh School of Medicine., Butter EM; Nationwide Children's Hospital of Columbus., Buchan-Page KA; Ohio State University, Columbus, OH., Hurt EA; Ohio State University, Columbus, OH., Austin AB; Ohio State University, Columbus, OH., Grondhuis SN; Ohio State University, Columbus, OH., Aman MG; Ohio State University, Columbus, OH.
Jazyk:	angličtina
Zdroj:	Journal of the American Academy of Child and Adolescent Psychiatry [J Am Acad Child Adolesc Psychiatry] 2014 Sep; Vol. 53 (9), pp. 948-959.e1. Date of Electronic Publication: 2014 Jun 12.
DOI:	10.1016/j.jaac.2014.05.008
Abstrakt:	Objective: In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication, and placebo (Basic therapy) versus parent training, stimulant, and risperidone (Augmented therapy) by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced impairment, and informant discrepancy. Method: Children (6-12 years of age; N = 168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks. Results: Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p = .002, Cohen's d = 0.27) and peer aggression (p = .02, Cohen's d = 0.32) but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at week 9/endpoint (p = .008). Teacher ratings indicated greater reduction in ADHD severity (p = .02, Cohen's d = 0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated as impaired for at least 1 targeted disorder at week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%). Conclusion: Augmented therapy was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context specific, and effect sizes ranged from small to moderate. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov/; NCT00796302. (Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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