TY - JOUR
T1 - Risperidone added to parent training and stimulant medication
T2 - Effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression
AU - Gadow, Kenneth D.
AU - Arnold, L. Eugene
AU - Molina, Brooke S.G.
AU - Findling, Robert L.
AU - Bukstein, Oscar G.
AU - Brown, Nicole V.
AU - McNamara, Nora K.
AU - Rundberg-Rivera, E. Victoria
AU - Li, Xiaobai
AU - Kipp, Heidi L.
AU - Schneider, Jayne
AU - Farmer, Cristan A.
AU - Baker, Jennifer L.
AU - Sprafkin, Joyce
AU - Rice, Robert R.
AU - Bangalore, Srihari S.
AU - Butter, Eric M.
AU - Buchan-Page, Kristin A.
AU - Hurt, Elizabeth A.
AU - Austin, Adrienne B.
AU - Grondhuis, Sabrina N.
AU - Aman, Michael G.
N1 - Funding Information:
This study was supported by grants from the National Institute of Mental Health (NIMH) to the Ohio State University (R01 MH077907), Case Western Reserve University (R01 MH077750), University of Pittsburgh (R01 MH077676), and Stony Brook University (R01 MH 077997). The project was also supported by a National Institutes of Health (NIH) General Clinical Research Center grant M01RR10710 (Stony Brook University) and Clinical and Translational Science Awards (CTSA) from the National Center for Advancing Translational Sciences grants 8UL1TR000090-05 (the Ohio State University) and UL1 RR024153 and UL1TR000005 (University of Pittsburgh). The content is solely the responsibility of the authors and does not necessarily represent the official views of the respective National Centers for Advancing Translational Sciences or NIH.
PY - 2014/9
Y1 - 2014/9
N2 - 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://clinicaltrails.gov/; NCT00796302.
AB - 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://clinicaltrails.gov/; NCT00796302.
KW - ADHD
KW - aggression
KW - multiple drug therapy
KW - risperidone
KW - stimulant drug
UR - http://www.scopus.com/inward/record.url?scp=84906934646&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84906934646&partnerID=8YFLogxK
U2 - 10.1016/j.jaac.2014.05.008
DO - 10.1016/j.jaac.2014.05.008
M3 - Article
C2 - 25151418
AN - SCOPUS:84906934646
SN - 0890-8567
VL - 53
SP - 948-959.e1
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 9
ER -