Pharmacological treatment of pathologic aggression in children

Children with psychiatric illness may display pathologic aggression (PA) that is destructive, severe, chronic, and unresponsive to psychosocial and psychopharmacological treatment of their underlying condition(s) and psychosocial interventions specifically targeting PA. For this subset of children with PA, pharmacotherapy may be an appropriate treatment option to optimize their functioning. This article reviews pharmacological treatment studies for PA in children and the safety and efficacy of risperidone, olanzapine, lithium, divalproex sodium, methylphenidate, and typical antipsychotics in this patient population. While safety needs to be emphasized when prescribing medication for these patients, serious health and safety risks are also raised when PA is not effectively treated. Future research is needed to evaluate whether the long-term risks associated with the pharmacological treatment of PA outweigh the potential benefits to the child.