title: Behavioral efficacy of haloperidol and lithium carbonate. A comparison in hospitalized aggressive children with conduct disorder. A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality. Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Diphenylhydantoin in children with severe temper tantrums. Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. The Overt Aggression Scale in a study of lithium in aggressive conduct disorder. Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. Methylphenidate in aggressive-hyperactive boys: I. Effects on peer aggression in public school settings. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. Adolescent Outcomes of Childhood Conduct Disorder Among Clinic-Referred Boys: Predictors of Improvement Molindone hydrochloride treatment of hospitalized children with conduct disorder. Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Efficacy and safety of mixed amphetamine salts extended release (adderall XR) in the management of oppositional defiant disorder with or without comorbid attention-deficit/hyperactivity disorder in school-aged children and adolescents: A 4-week, multicenter, randomized, double-blind, parallel-group, A double-blind pilot study of risperidone in the treatment of conduct disorder. Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling Effects of methylphenidate on adolescents with aggressive conduct disorder and ADDH: a preliminary report. A randomized controlled trial of risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities. A Pilot Study of Methyiphenidate, Clonidine, or the Combination in ADHD Comorbid with Aggressive Oppositional Defiant or Conduct Disorder Lithium treatment of conduct disorders in adolescents. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. A randomized controlled trial of clonidine added to psychostimulant medication for hyperactive and aggressive children. Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. P.r.n. medications in child psychiatric patients: a pilot placebo-controlled study. An open trial of bupropion for ADHD in adolescents with substance use disorders and conduct disorder. Which boys respond to stimulant medication? A controlled trial of methylphenidate in boys with disruptive behaviour. Reboxetine as an optional treatment for hyperkinetic conduct disorder: a prospective open-label trial. Cognitive effects of lithium carbonate and haloperidol in treatment-resistant aggressive children. A controlled trial of haloperidol in children. Acute and chronic administration of trazodone in the treatment of disruptive behavior disorders in children. Carbamazepine in aggressive children with conduct disorder: a double-blind and placebo-controlled study. A randomized controlled trial of pemoline for attention-deficit/hyperactivity disorder in substance-abusing adolescents. Neuroleptic-related dyskinesias in children and adolescents. The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: main and incremental effects across settings. Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. Haloperidol in the treatment of children with severe behaviour disorders. Prescribing practices of outpatient child psychiatrists.
abstract: The efficacy and safety of haloperidol , lithium carbonate , and placebo were critically assessed in 61 treatment-resistant , hospitalized children aged 5.2 to 12.9 years with diagnoses of conduct disorder , aggressive type . In this double-blind and well-controlled study , the optimal dosages of haloperidol ranged from 1.0 to 6.0 mg/day and those of lithium carbonate from 500 to 2,000 mg/day . For the assessment of behavioral changes and untoward effects , various rating scales were used in different setting s. Both haloperidol and lithium carbonate were found to be significantly superior to placebo in decreasing behavioral symptoms . Although both medications were clinical ly effective , haloperidol was associated more often with untoward effects than was lithium carbonate OBJECTIVE To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects . METHOD In this prospect i ve study , adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years . The official arrest records for all subjects were obtained . RESULTS Hyperactive subjects had significantly higher juvenile ( 46 % versus 11 % ) and adult ( 21 % versus 1 % ) arrest rates . Juvenile and adult incarceration rates were also significantly higher . Childhood conduct problems predicted later criminality , and serious antisocial behavior in adolescence predicted adult criminality . CONCLUSIONS Hyperactive children are at risk for both juvenile and adult criminality . The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior ( repeat offending ) in adolescence . Hyperactive children who do not have conduct problems are not at increased risk for later criminality BACKGROUND Stimulants are not considered appropriate for the treatment of children with conduct disorders ( CDs ) . The postulated differences in stimulant effect between children with attention deficit hyperactivity disorder ( ADHD ) and CD led to the hypothesis that methylpheni date hydrochloride , which is effective in ADHD , would not significantly improve symptoms of CD . METHODS We r and omly assigned 84 children with CD , between the ages of 6 and 15 years , to receive methylpheni date hydrochloride ( up to 60 mg/d ) or placebo for 5 weeks . Behavior was evaluated by parent , teacher , and clinician reports and by direct classroom observations . Two thirds of the children also met criteria for ADHD . RESULTS Contrary to prediction , ratings of antisocial behaviors specific to CD were significantly reduced by methylpheni date treatment . The magnitude of methylpheni date effect indicated meaningful clinical benefit . Partialling out severity of ADHD did not alter the significant superiority of methylpheni date on CD ratings specifically ( P < .001 ) . CONCLUSIONS Methylpheni date has short-term positive effects on children and adolescents with CD . Key aspects of antisocial adjustment appear to be treatment responsive . This effect was independent of severity of the children 's initial ADHD symptoms THE CONCEPT of minimal brain dysfunction ( MBD ) was developed to account for a variety of obscure behavioral abnormalities often considered purely functional in nature . 1 - 4 In a recent review of the subject Pincus and Glaser 2 describe the motor , perceptual , and behavioral characteristics that comprise the MBD syndrome . They state that MBD is a " behavioral diagnosis . " The children afflicted show  " inappropriate activity  , " "  disordered attention span  , " " poorly controlled behavior  , " "  impulsiveness with destructive elements , " " hyperkinesis , " " outbursts of aggression , temper tantrums , sexual displays . " There may be motor , perceptual , reading , and writing impairment , as well as poor ability at copying complex Gestalten . 5 - 7 There is often a history of delayed developmental milestones as well as organic cerebral trauma due to complications of pregnancy , traumatic birth , head trauma , or intracerebral infection after birth . Abnormal behavior such as violent aggressiveness or lack of attention at school may thus be seen as due , in part , to BACKGROUND Prior research indicates that conduct disorder ( CD ) is associated with a range of co-morbid mental disorders . However , the actual prevalence , subtypes and patterns of co-morbidity of DSM-IV-defined CD in the general US population remains unknown . METHOD Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents ( n=3199 ) in the National Comorbidity Survey Replication ( NCS-R ) . RESULTS The estimated lifetime prevalence of CD in the US is 9.5 % ( 12.0 % among males and 7.1 % among females ) , with a median age-of-onset of 11.6 ( 0.2 ) years . Latent class analysis ( LCA ) identified five CD subtypes characterized by rule violations , deceit/theft , aggression , severe covert behaviors , and pervasive CD symptoms . A dose-response relationship was revealed between CD subtype severity and risk of subsequent disorders . Results also indicated that CD typically precedes mood and substance use disorders , but most often occurs after impulse control and anxiety disorders . Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders , remitted CD is associated with significantly lower risk of subsequent disorders . CONCLUSIONS CD is prevalent and heterogeneous in the US population , and more severe subtypes and the presence of active CD are associated with higher risk of co-morbid disorders . Future prospect i ve studies using general population sample s will further inform the nature and course of this disorder This article describes an open study of lithium carbonate in conduct-disordered children . The objective of the study was to investigate the effectiveness of lithium in reducing aggression and the usefulness of the Overt Aggression Scale ( OAS ) , as a measure of treatment effect . The subjects , 8 children , ages 9.2 to 16.9 years ( mean + /- st and ard deviation [ SD ] = 12.48 + /- 2.97 ) , were treated for 4 weeks with lithium . Optimal dosages ranged from 1200 to 1800 mg/day ( mean = 1350 + /- 227 ) with corresponding serum lithium levels ranging from 0.86 to 1.39 mEq/L ( mean = 1.05 + /- 0.17 ) . OAS results indicated that aggression decreased significantly over time . The findings from the OAS agreed with findings from a more general measure , the Global Clinical Consensus Rating , leading to the conclusion that the OAS is a promising outcome measure for treatment studies of aggression in children . Further placebo-controlled studies of lithium carbonate in reducing aggressive behavior in conduct-disordered children , employing a specific measure such as the OAS , are warranted OBJECTIVE To assess critically the efficacy and safety of lithium and replicate earlier findings in a larger sample of aggressive children with conduct disorder and to assess the utility of the Profile of Mood States ( POMS ) in this population . METHODS Children hospitalized for treatment-refractory severe aggressiveness and explosiveness and with diagnosed conduct disorder were subjects in this double-blind , placebo-controlled clinical trial . After a 2-week placebo baseline period , children were r and omly assigned to lithium or placebo treatment for 6 weeks of placebo . The main outcome measures were the Global Clinical Judgments ( Consensus ) Scale , Children 's Psychiatric Rating Scale , Conners Teacher Question naire , Parent-Teacher Question naire , and the POMS . RESULTS Fifty children ( mean age 9.4 years ) completed this study . The mean optimal daily dose of lithium was 1,248 mg and the mean serum level was 1.12 mEq/L. Lithium was superior to placebo , although the effects on some measures were more modest than in a previous study . CONCLUSIONS Lithium appears to be an effective treatment for some severely aggressive children with conduct disorder . Although the POMS appeared to be reliable , it did not detect any response to lithium One of the least documented " known " effects of methylpheni date in hyperactive children is the suppression of peer aggression . In this study , 11 aggressive-hyperactive children received a low ( 0.3 mg/kg ) and moderate ( 0.6 mg/kg ) dose of methylpheni date and placebo for 2 weeks each under double-blind conditions . Children were observed in public school setting s during classroom seatwork activities , lunch , and recess . Results showed that methylpheni date suppressed nonphysical aggression ( p = 0.06 ) in the classroom , and a moderate dose decreased physical aggression ( p less than 0.01 ) and verbal aggression ( p = 0.07 ) on the playground . The effect on the rate of appropriate social interaction was variable . The majority of subjects exhibited either the same or higher levels of appropriate social interaction on the 0.6 mg/kg dose compared with placebo . In the classroom , both doses of methylpheni date also result ed in reduced levels of motor movement , off-task behavior , noncompliance , and disruptiveness . Teacher ratings of hyperactivity and conduct problem symptoms revealed drug effects , whereas parallel parent instruments did not OBJECTIVE To determine whether risperidone is effective in reducing symptoms of disruptive behaviors ( such as aggression , impulsivity , defiance of authority figures , and property destruction ) associated with conduct disorder , oppositional defiant disorder , and disruptive behavior disorder-not otherwise specified in children with subaverage IQs . METHOD The trial consisted of a 1-week , single-blind , placebo run-in period and was followed by a 6-week , double-blind , placebo-controlled period . One hundred ten children ( aged 5 - 12 years inclusive ) with an IQ of 36 - 84 with a disruptive behavior disorder and a score of at least 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form ( NCBRF ) were enrolled . Eighty percent of subjects had comorbid attention-deficit/hyperactivity disorder ( ADHD ) .  Risperidone doses ranged from 0.02 to 0.06 mg/kg per day . Subjects were rated on the NCBRF , Aberrant Behavior Checklist , Behavior Problems Inventory , Clinical Global Impressions ( CGI ) , modified California Verbal Learning Test ( CVLT ) , and a continuous performance task ( CPT ) . RESULTS The intention-to-treat analysis of risperidone-treated subjects showed a significant ( p < .001 ) reduction in mean scores ( from 33.4 at baseline to 17.6 at end point ; 47.3 % reduction ) versus placebo-treated subjects ( mean baseline of 32.6 to 25.8 at end point ; 20.9 % reduction ) on the Conduct Problem subscale of the NCBRF . Between-group differences in favor of risperidone were seen as early as week 1 and were significant at all post-baseline visits . Other subscales showed significant improvement with risperidone compared with placebo .  CGI scale ratings of improvement showed highly significant gains for risperidone over placebo . A sub analysis demonstrated that the effect of risperidone was unaffected by diagnosis , presence/absence of ADHD , psychostimulant use , IQ status , and somnolence .  Risperidone produced no changes on the cognitive variables ( CPT/modified CVLT ) . The most common side effects included somnolence , headache , appetite increase , and dyspepsia . Side effects related to extrapyramidal symptoms were reported in 7 ( 13.2 % ) and 3 ( 5.3 % ) of the subjects in the risperidone and placebo groups , respectively ( p = .245 ) . CONCLUSIONS Risperidone appears to be an adequately tolerated and effective treatment in children with subaverage IQs and severe disruptive behaviors such as aggression and destructive behavior Much remains to be learned about the adolescent outcomes of clinic-referred boys whose childhood conduct problems are serious enough to meet diagnostic criteria for conduct disorder ( CD ) .  Six structured diagnostic assessment s were conducted over 7 years of 73 clinic-referred 7–12-year-old boys who met criteria for CD in Wave 1 . There were substantial individual differences in the adolescent outcomes of CD , ranging from worsening to sustained recovery , with most boys showing persistent , but fluctuating levels of CD . Improvement in CD was not accounted for by treatment or incarceration , but more positive outcomes over Waves 2–7 were predicted prospect ively with substantial accuracy , using a combination of baseline predictors : less initial severity of CD , fewer symptoms of attention-deficit hyperactivity disorder , higher child verbal intelligence , greater family socioeconomic advantage , and not having antisocial biological parents Treatment-emergent symptoms and behavioral changes were assessed during an 8-week double-blind study comparing molindone and thioridazine in 31 aggressive hospitalized children ( ages 6 - 11 ) .  Molindone was found to be as effective as thioridazine in this sample . Adverse effects differed ( nonsignificantly ) for the two groups , with more sedation in the thioridazine-treated children . Clinical records from 6 adolescent in patients treated with molindone were review ed as a comparison group . Molindone is a relatively safe neuroleptic for child and adolescent in patients because of its short half-life and minimal prolonged tissue accumulation . Additional studies on different child population s are necessary before the proper indications for molindone usage in the pediatric group can be established OBJECTIVE The authors sought to replicate open-label findings showing that specific criteria for explosive temper and mood lability identify disruptive youth who improve while receiving the anticonvulsant divalproex sodium . METHOD Twenty outpatient children and adolescents ( ages 10 - 18 ) with a disruptive behavior disorder ( oppositional defiant disorder or conduct disorder ) met the specific criteria for explosive temper and mood lability . They received 6 weeks of divalproex treatment and 6 weeks of placebo by r and om assignment . Independent evaluators blind to group assignment assessed response at the end of each phase . RESULTS At the end of phase 1 , eight of 10 subjects had responded to divalproex ; zero of 10 had responded to placebo . Of the 15 subjects who completed both phases , 12 has superior response taking divalproex . CONCLUSIONS This preliminary study replicates open-label findings showing that divalproex is an efficacious treatment for explosive temper and mood lability in disruptive children and adolescents BACKGROUND Oppositional defiant disorder (ODD)is associated with a high degree of impairment in social skills , family interaction , and academic functioning . Comorbid ODD is reportedly present in 40 % to 70 % of children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . OBJECTIVE The goal of this study was to assess the efficacy and safety of mixed amphetamine salts extended release ( MAS XR ) for the treatment of ODD in children and adolescents aged 6 to 17 years . METHODS This was a 4-week , multicenter , r and omized , double-blind , parallel-group , placebo-controlled , forced-dose-escalation study . Patients were r and omized to receive active treatment with MAS XR 10 , 20 , 30 , or 40 mg/d or placebo . The primary efficacy end point was the ODD subscale of the Swanson , Nolan , and Pelham-IV ( SNAP-IV ) parent rating . Primary safety measures included adverse events recorded at each visit and for 30 days after study drug discontinuation , and changes in vital signs , 12-lead electrocardiographic ( ECG ) findings , laboratory tests and physical examinations , and body weight . A post hoc efficacy re analysis was completed based on the results for the per- protocol population . For this analysis , patients were divided into high and low baseline severity categories according to the dichotomized baseline ODD parent or teacher score or dichotomized baseline ADHD parent or teacher score ( high defined as scores at the median or greater and low defined as scores less than the median ) . RESULTS A total of 308 children and adolescents ( age range , 6 - 17 years ; 213 males , 95 females ) were r and omized to receive active treatment with MAS XR 10 mg/d ( n = 60 ) 20 mg/d ( n = 58 ) , 30 mg/d ( n = 69 ) , or 40 mg/d ( n = 61 ) or placebo ( n = 60 ) . Of the 308 study patients , 244 ( 79.2 % ) had comorbid ADHD . A significant change from baseline in the ODD symptoms measured with the SNAP-IV parent rating subscale was found for the MAS XR 30-mg/d ( -0.52 ; P < 0.001 ) and 40-mg/d ( -0.56 ; P = 0.002 ) groups in the per- protocol analysis and for the MAS XR 30-mg/d group in the intent-to-treat analysis ( -0.42 ; P < 0.005 ) . Throughout the study , MAS XR was well tolerated in these children and adolescents with ODD , and most adverse events were mild to moderate in intensity . The most frequently reported adverse events occurring in MAS XR-treated patients were anorexia/decreased appetite ( 25.3 % ) , insomnia ( 19.5 % ) , headache ( 18.5 % ) , and abdominal pain ( 10.7 % ) . Statistically , but not clinical ly , significant decreases in body weight were seen with MAS XR ( range , -1.1 to -3.5 lb ; P < 0.001 vs placebo ) . Changes in laboratory values , ECG measurements , and physical and other vital signs were also not clinical ly significant . The post hoc re analysis was based on the per- protocol population ( n = 229 ) . An assessment of the high baseline symptom severity subgroups showed a good response to MAS XR treatment for the SNAP-IV parent and teacher rating scales ( both , P < 0.05 ) . CONCLUSION This study found that higher doses ofMAS XR ( 30 and 40 mg ) were effective and well tolerated in the management of ODD in these school aged children and adolescents in the presence or absence of ADHD OBJECTIVE To examine whether risperidone is superior to placebo in the treatment of youths with conduct disorder . METHOD This was a 10-week , r and omized , double-blind , placebo-controlled study with 2 parallel arms . Ten youths were r and omly assigned to receive placebo and 10 youths were r and omly assigned to receive risperidone .  Patients were seen weekly throughout the trial . Medications could be increased at weekly intervals during the first 6 weeks of the study from an initial dose of 0.25 mg or 0.50 mg each morning , depending on patient weight . Patients weighing less than 50 kg had a maximum total daily dose of risperidone of 1.5 mg . Patients weighing 50 kg or greater had a maximum total daily dose of risperidone of 3.0 mg . The primary outcome measure was the Rating of Aggression Against People and /or Property Scale . RESULTS Risperidone was superior to placebo in ameliorating aggression on most measures . Risperidone was reasonably well tolerated , with none of the risperidone-treated patients developing extrapyramidal side effects . CONCLUSIONS These data provide preliminary evidence that risperidone may have efficacy in the treatment of youths with conduct disorder . Because of the small sample size and the brief length of this study , further research is necessary to confirm these findings OBJECTIVE The aim of this study was to examine the safety and efficacy of risperidone , with or without concomitant psychostimulant use , in the treatment of children with conduct disorder ( CD ) or other disruptive behavior disorders [ oppositional defiant disorder ( ODD ) , disruptive behavior disorder-not otherwise specified ( DBD-NOS ) ] , and comorbid attention-deficit hyperactivity disorder ( ADHD ) . METHODS Data from two 6-week placebo-controlled trials assessing risperidone therapy in children with subaverage IQs and CD , ODD , DBD-NOS were combined , and patients with comorbid ADHD were selected for this post hoc analysis . Patients were grouped according to r and omized drug therapy ( risperidone or placebo ) , and then subgrouped according to their use of a concomitant psychostimulant .  Safety outcomes included adverse events and weight change , while efficacy outcomes included changes in scores on disruptive behavior and hyperactivity-based subscales of two behavior-rating instruments ( Nisonger Child Behavior Rating Form and the Aberrant Behavior Checklist ) . RESULTS The analysis included 155 of 208 originally tested children divided into four sub-groups ( 35 - 43 patients each ) . There was no significant difference in the frequency of adverse events in patients who received  risperidone  alone and those who received risperidone plus a stimulant . The most common adverse events in risperidone-treated patients were somnolence , headache , dyspepsia , rhinitis , and vomiting . Within each r and omized treatment group , actual weight gain was comparable , regardless of concomitant stimulant use . Risperidone-treated patients had clinical ly and statistically significant reductions in both disruptive behavior and hyperactivity subscale scores , compared to placebo , regardless of concomitant stimulant use . The addition of risperidone to a psychostimulant result ed in significantly better control of hyperactivity ( p < 0.001 ) than was achieved with stimulant treatment alone , without causing an increase in adverse events . CONCLUSION Risperidone was a safe and effective treatment , with or without a combined psychostimulant , for both disruptive behavior disorders and comorbid ADHD in children BACKGROUND The authors ' goal was to assess the efficacy and tolerability of naltrexone in the treatment of pathologic gambling disorder . METHODS Eighty-three subjects who met criteria for DSM-IV pathologic gambling disorder were enrolled in a 1-week single-blind placebo lead-in followed by an 11-week double-blind naltrexone or placebo trial . Naltrexone was started at 25 mg/day and titrated upward until maximum symptom improvement or 250 mg/day was achieved . Gambling symptom change was assessed with the patient-rated Clinical Global Impression ( PG-CGI-PT ) , clinician-rated CGI ( PG-CGI-MD ) , and the Gambling Symptom Rating Scale ( G-SAS ) . Side effects were monitored weekly and liver function tests biweekly . RESULTS Data from 45 patients were analyzed . Using r and om regression analysis , significant improvement was noted in all three gambling symptom measures : patient-rated Clinical Global Impression , p < .001 ; clinician-rated CGI , p < .001 ; Gambling Symptom Rating Scale , p < .019 . At study end , 75 % of subjects taking naltrexone were much or very much improved on both the PE-CEI PT and the PG-CGI-MD , compared with only 24 % of those on placebo .  Elevated liver enzymes occurred in four subjects who were taking analgesics concurrently . Nausea was common during the first week of treatment . CONCLUSIONS Results suggest that naltrexone is effective in reducing the symptoms of pathologic gambling . Until further studies corroborate the present findings , our report should be interpreted cautiously The effect of methylpheni date on aggression in adolescents diagnosed with both aggressive conduct disorder and attention deficit disorder with hyperactivity was assessed in nine male adolescents . After three open trials , a placebo controlled double-blind design was used . During methylpheni date treatment of the six double-blind subjects , there was a significant reduction of aggressivity ( p 's less than 0.05 ) , as measured by the Adolescent Antisocial Behavior Checklist . Conners Teacher Rating Scale Hyperactivity and Aggression scores were in the predicted directions , but the differences were not statistically significant BACKGROUND Risperidone is an atypical antipsychotic drug that blocks dopamine as well as serotonin receptor systems . The present study was design ed to examine the efficacy and safety of risperidone in a 6-week double-blind , r and omized , parallel-group design in the treatment of aggression in adolescents with a primary diagnosis of DSM-IV disruptive behavior disorders and with subaverage intelligence . METHOD We r and omly assigned 38 adolescents ( 33 boys ; 10 subjects with slightly subaverage IQ , 14 with borderline IQ , and 14 with mild mental retardation ) , who were hospitalized for treatment of psychiatric disorders associated with severe aggression , to receive  risperidone or placebo . The main efficacy measures were the Clinical Global Impressions-Severity of Illness scale ( CGI-S ) , the modified Overt Aggression Scale ( OAS-M ) , and the Aberrant Behavior Checklist ( ABC ) . Side effects were measured using the Extrapyramidal Symptom Rating Scale ( ESRS ) . RESULTS The mean daily dose of risperidone at the end of treatment was 2.9 mg ( range , 1.5 - 4 mg ) . Risperidone , compared with placebo , was associated with significant improvements on the CGI-S ( p < .001 ) and the at-school ABC overall and hyperactivity scales ( p < .05 ) . During a 2-week washout following the 6-week trial , a statistically significant worsening was found in the risperidone group on the CGI-S scale , the OAS-M. and the ABC . Extrapyramidal symptoms were absent or very mild during risperidone treatment . Transient tiredness was present in 11 ( 58 % ) of 19 drug-treated subjects . Other untoward effects included sialorrhea , nausea , and slight weight gain ( mean = 3.5 % of body weight in the risperidone group ) . No clinical ly relevant changes were found in laboratory parameters , electrocardiogram , heart rate , or blood pressure . CONCLUSION These results suggest that risperidone may be effective for severe aggression in adolescents with disruptive behavior disorders and subaverage intelligence , and these results are consistent with reports suggesting its effectiveness for treating severe aggression in adolescents in general A pilot comparison of the safety and efficacy of methylpheni date ( MPH ) combined with clonidine , clonidine monotherapy , or MPH monotherapy in 6to 16-year-old children diagnosed with attention deficit hyperactivity disorder ( ADHD ) and comorbid aggressive oppositional defiant disorder or conduct disorder was completed . Study design was a 3-month , r and omized , blinded , group comparison with eight subjects per group . No placebo comparison was used . All three treatment groups showed significant improvements in attention deficits , impulsivity , oppositional , and conduct disordered symptoms as assessed by parent and teacher rating scales and laboratory measures . Significant differences among treatment groups were found only on a few measures . Only the clonidine monotherapy group showed significantly decreased fine motor speed . These results suggest the safety and efficacy of clonidine alone or in combination with MPH for the treatment of ADHD and aggressive oppositional and conduct disorders OBJECTIVE The authors examined the efficacy of lithium carbonate for treating  conduct disorder in adolescents . METHOD The subjects were 33 in patients aged 12 - 17 years .  Lithium or placebo was administered in a double-blind fashion for 2 weeks . RESULTS On several measures of clinical change the groups showed no significant differences . Of the patients who completed the study , 8.3 % of those receiving placebo ( one of 12 ) versus 21.4 % ( three of 14 ) of those receiving lithium were considered responders . CONCLUSIONS Lithium does not appear beneficial for this indication BACKGROUND A subgroup of children and adolescents with conduct disorder are characterized by severe and persistent aggression . Although there is no agreed on treatment for such aggression , lithium carbonate has shown promise in some studies involving children . Our study was design ed to critically assess the efficacy of lithium in the treatment of aggression in children and adolescents using a measure specific for aggression . METHODS Subjects were in patients with conduct disorder hospitalized because of severe and chronic aggression . A parallel-groups design was used in this double-blind , placebo-controlled trial with r and omization to lithium or placebo . Only those who met the aggression criterion during the 2-week placebo-baseline period were r and omized to 4 weeks of treatment . Outcome measures included Clinical Global Impressions , the Global Clinical Judgements ( Consensus ) Scale , and the Overt Aggression Scale . RESULTS Eighty-six in patients enrolled in the study ; 40 ( 33 male and 7 female ; median age , 12.5 years ) entered and completed the treatment phase . Lithium was statistically and clinical ly superior to placebo . Sixteen of 20 subjects in the lithium group were responders on the Consensus ratings vs 6 of 20 in the placebo group ( P=.004 ) . Ratings on the Overt Aggression Scale decreased significantly for the lithium group vs the placebo group ( P=.04 ) . More than half of the subjects in the lithium group experienced nausea , vomiting , and urinary frequency . CONCLUSIONS Lithium is a safe and effective short-term treatment for aggression in in patients with conduct disorder , although its use is associated with adverse effects OBJECTIVE The authors compared the effects of maintenance versus withdrawal of risperidone treatment in children and adolescents with symptoms of disruptive behavior disorder . METHOD Patients with disruptive behavior disorder ( 5 - 17 years of age and a range of intellect ) who had responded to risperidone treatment over 12 weeks were r and omly assigned to 6 months of double-blind treatment with either risperidone or placebo . The primary efficacy measure was time to symptom recurrence , defined as sustained deterioration on either the Clinical Global Impression severity rating ( /2 points ) or the conduct problem subscale of the Nisonger Child Behavior Rating Form ( /7 points ) . Secondary efficacy measures included rates of discontinuation due to symptom recurrence , disruptive behavior disorder symptoms , and general function . Safety and tolerability were also assessed . Risperidone dosage was based on weight ( patients < 50 kg : 0.25 - 0.75 mg/day ; patients /50 kg : 0.5 - 1.5 mg/day ) . RESULTS Treatment was initiated in 527 patients , with 335 r and omly assigned to a double-blind maintenance condition . Time to symptom recurrence was significantly longer in patients who continued risperidone treatment than in those switched to placebo .  Symptom recurrence in 25 % of patients occurred after 119 days with risperidone and 37 days with placebo . Secondary efficacy measures also favored risperidone over placebo .  Weight increased over the initial 12 weeks of treatment ( mean weight z score change=0.2 , SD=2.7 , N=511 ) , after which it plateaued . CONCLUSIONS This study is the first placebo-controlled maintenance versus withdrawal trial of its kind in disruptive behavior disorder and provides evidence that patients who respond to initial treatment with risperidone  would benefit from continuous treatment over the longer term OBJECTIVE To compare clonidine with placebo added to ongoing psychostimulant therapy for the treatment of attention-deficit/hyperactivity disorder with comorbid oppositional defiant disorder or conduct disorder . METHOD Children 6 to 14 years of age recruited through 2000 to 2001 were r and omized to receive clonidine syrup 0.10 to 0.20 mg/day ( n = 38 ) or placebo ( n = 29 ) for 6 weeks . Primary outcome measures were the Conduct and Hyperactive Index subscales of the parent-report Conners Behavior Checklist . Side effects were monitored using physiological measures and the Barkley Side Effect Rating Scale . RESULTS Evaluable patient analysis showed that significantly more clonidine-treated children than controls were responders on the Conduct scale ( 21 of 37 versus 6 of 29 ; chi2(1 ) = 8.75 , p < .01 ) but not the Hyperactive Index ( 13 of 37 versus 5 of 29 ) . Compared with placebo , clonidine was associated with a greater reduction in systolic blood pressure measured st and ing and with transient sedation and dizziness .  Clonidine-treated individuals had a greater reduction in a number of unwanted effects associated with psychostimulant treatment compared with placebo . CONCLUSIONS The findings support the continued use of clonidine in combination with psychostimulant medication to reduce conduct symptoms associated with attention-deficit/hyperactivity disorder . Treatment is well tolerated and unwanted effects are transient OBJECTIVE The short-term efficacy and safety of risperidone in the treatment of disruptive behaviors was examined in a well-characterized cohort of children with subaverage intelligence . METHOD In this 6-week , multicenter , double-blind , parallel-group study of 118 children ( aged 5 - 12 years ) with severely disruptive behaviors and subaverage intelligence ( IQ between 36 and 84 , inclusive ) , the subjects received 0.02 - 0.06 mg/kg per day of risperidone oral solution or placebo . The a priori primary efficacy measure was the change in score from baseline to endpoint on the conduct problem subscale of the Nisonger Child Behavior Rating Form . RESULTS The risperidone group showed significantly greater improvement than did the placebo group on the conduct problem subscale of the Nisonger Child Behavior Rating Form from week 1 through endpoint ( change in score of -15.2 and -6.2 , respectively ) . Risperidone was also associated with significantly greater improvement than placebo on all other Nisonger Child Behavior Rating Form subscales at endpoint , as well as on the Aberrant Behavior Checklist subscales for irritability , lethargy/social withdrawal , and hyperactivity ; the Behavior Problems Inventory aggressive/destructive behavior subscale ; a visual analogue scale of the most troublesome symptom ; and the Clinical Global Impression change score . The most common adverse effects reported during risperidone treatment were headache and somnolence . The extrapyramidal symptom profile of risperidone was comparable to that of placebo .  Mean weight increases of 2.2 kg . and 0.9 kg occurred in the risperidone and placebo groups , respectively . CONCLUSIONS Risperidone was effective and well tolerated for the treatment of severely disruptive behaviors in children with subaverage IQ BACKGROUND The administration p.r.n . ( as needed ) of sedative medications is a widespread practice in the management of acute dyscontrol of child psychiatric in patients . Its efficacy , however , has never been tested in a controlled clinical trial . METHOD Twenty-one male in patients , aged 5 - 13 years , participated in a double-blind , placebo-controlled study of the p.r.n . use of diphenhydramine , a sedative antihistaminic often used in child psychiatry wards . The patients ' DSM-III-R diagnoses were conduct disorder , attention-deficit hyperactivity , and major depression . Each patient in acute dyscontrol blindly received either oral or intramuscular doses of diphenhydramine 25 - 50 mg ( N = 9 ) or placebo ( N = 12 ) . The Conners Abbreviated 10-Item Teacher Rating Scale and the Clinical Global Impressions scale were completed before and 0.5 , 1 , and 2 hours after the dose . RESULTS Repeated measures ANOVA showed significant time effects , but no difference due to drug . The intramuscular route tended to be more effective than the oral , regardless of whether active drug or placebo was given . CONCLUSION The data indicate that if p.r.n . administrations are effective , this is a placebo effect . Likewise , intramuscular administrations are more effective because of a route effect ( " the needle " ) and not because of a specific pharmacologic activity OBJECTIVE Adolescents with conduct disorder ( CD ) and substance use disorders ( SUD ) have higher rates of comorbid attention-deficit/hyperactivity disorder ( ADHD ) than those without CD and SUD . Comorbid ADHD may contribute to more severe SUD . Treatment of ADHD may enhance effective treatment of substance abuse and behavior problems , yet there are few data regarding pharmacological treatment of ADHD in such youths . METHOD Pilot data are presented from a 5-week , open-label bupropian trial in 13 nondepressed adolescent boys in a residential treatment program focusing on substance and behavioral treatments . All had diagnoses of ADHD , CD , and SUD . Patients ' doses were titrated to a maximum fixed daily dose of 300 mg of bupropion . The Conners Hyperactivity Index and Daydream Attention scores , along with Clinical Global Impressions Severity of Illness ( CGI-S ) ratings , were obtained at baseline and at the fifth week of treatment . RESULTS Subjects ' mean Conners Hyperactivity Index score declined from 75.5 to 65.4 ( p < .01 , Wilcoxon signed rank test ) ( 13 % decline ) . The mean Daydream Attention score declined from 59.5 to 53.6 ( p < .02 , Wilcoxon signed rank test ) ( 10 % decline ) . Mean CGI-S declined from 4.9 to 3.0 ( p < .002 , Wilcoxon signed rank test ) ( 39 % decline ) . CONCLUSIONS These preliminary data suggest that bupropion may be a useful treatment for ADHD in adolescents with CD and SUD ; they suggest the need for a controlled trial of bupropion in such youths Thirty-eight boys , referred for psychiatric treatment because of serious problems of behaviour , underwent a double-blind , placebo-controlled , crossover trial of methylpheni date and placebo . Methylpheni date was an effective treatment over a 3-week period . A good response to methylpheni date was predicted by higher levels of inattentive and restless behaviour , impaired performance on tests of attention , clumsiness , younger age and by the absence of symptoms of overt emotional disorder . DSM-III and ICD-9 diagnoses of ' hyperactivity ' were not good predictors . The results support the validity of a construct of hyperactivity in describing childhood psychopathology , but emphasize the need for a refinement of diagnostic criteria BACKGROUND AND PURPOSE Hyperkinetic conduct disorder ( HCD ) has been identified as a common psychiatric diagnosis among children and adolescents . This disorder affects many life aspects of both child and family . The aim of this study was to examine the efficacy of the selective norepinephrine reuptake inhibitor ( SNRI ) , reboxetine , in treating children with HCD and its influence on associated symptoms , such as aggressiveness , impulsivity , anxiety , and depression . METHODS Fifteen children , 5 - 14 years of age , diagnosed with HCD , participated in a 12- week , prospect i ve , open-label trial with reboxetine ( 4 - 8 mg/d ) . They were examined for changes in : ADHD symptoms , as measured by the Conners Abbreviated ( 10-item ) Teacher Rating Scale , aggression , as measured by the Yudofsky Overt Aggression Scale ( OAS ) , impulsivity , as measured by the Plutchik impulsivity scale ( IS ) , anxiety , as measured by the Revised Children 's Manifest Anxiety Scale ( RCMAS ) , and depressive mood , as measured by the Hamilton Rating Scale for Depression ( HAM-D ) . RESULTS There was a significant symptomatic improvement for HCD symptoms and associated symptoms . CONCLUSION Our findings suggest that reboxetine may be effective in the treatment of HCD and associated symptoms The effects of lithium carbonate and haloperidol on cognition were examined in a placebo-controlled , double-blind study of 61 treatment-resistant , hospitalized school-aged children . They all had a DSM-III diagnosis of conduct disorder-- undersocialized , aggressive , with a profile of highly explosive and aggressive behavior . Children were assessed at the end of a two-week placebo-baseline period and again after four weeks of treatment . Drug effects on cognition were mild . Haloperidol ( mean dose , 2.95 mg/day ) caused significant decreases in Porteus Maze test quotient scores and a slowing of reaction time ( RT ) on a simple RT task . Lithium carbonate ( mean dose , 1,166 mg/day ) adversely affected qualitative scores on the Porteus Maze test . No significant treatment effects were found for the Matching Familiar Figures Test , short-term recognition memory and concept attainment tasks , or the Stroop Test A controlled , double-blind , crossover trial of haloperidol in a group of 16 children with behaviour disorders is described . Selection was based on the presence of at least four of the following symptoms : overactivity , restlessness , aggressiveness , temper , attention-seeking behaviour , disobedience , destructiveness , poor concentration . Benzhexol was administered concurrently with both active and placebo tablets .  Thirteen children were rated as better on haloperidol , two as better on placebo and one as showing no difference . This result is statistically significant . Side-effects were minimal . It is concluded that haloperidol merits more extensive trial in conditions of the type studied We report the results of an open trial of trazodone in the treatment of  severe behavioral disturbances in a sample of 22 hospitalized children previously found to be unresponsive to other treatments . Response to treatment was assessed by overall clinical criteria and improvements in individual symptom dimensions during the inpatient hospitalization . Thirteen children ( 67 % ) were found to benefit from the introduction of trazodone .  Aggressive , impulsive behaviors were symptoms most frequently improved by this agent . Three of those found to be nonresponders actually worsened in symptomatology . A follow-up interview of the parents was conducted 3 - 14 months after discharge from the inpatient unit , for those children who initially responded to trazodone administration . The results of this interview suggest that the effect of trazodone was persistent for a prolonged period of time after the initial inpatient trial . Trazodone appears to be of value in the management of  severe behavioral disturbances in children . The possible mechanism of action of trazodone is discussed OBJECTIVE To assess critically the short-term efficacy and safety of carbamazepine in the reduction of aggressiveness in children with diagnosed conduct disorder . METHOD Subjects were children aged 5 to 12 years who were hospitalized for treatment-resistant aggressiveness and explosiveness and who had diagnosed conduct disorder . The study was double-blind and placebo-controlled , using a parallel-groups design . Following a 2-week placebo baseline period , children who met the aggression criteria were r and omly assigned to treatments for 6 weeks ; the study ended with a 1-week posttreatment placebo period . Multiple raters rated the children independently , using multiple rating scales under four conditions . The main outcome measures included the Overt Aggression Scale , the Global Clinical Judgments ( Consensus ) Scale , and the Children 's Psychiatric Rating Scale . RESULTS Twenty-two children , aged 5.33 to 11.7 years , completed the study .  Carbamazepine was not superior to placebo at optimal daily doses ranging from 400 to 800 mg , mean 683 mg , at serum levels of 4.98 to 9.1 micrograms/mL. Untoward effects associated with administration of carbamazepine were common . CONCLUSIONS In this modest sample of children , the superiority of carbamazepine over placebo in reducing aggressive behavior was not demonstrated OBJECTIVE In adolescents with substance use disorder ( SUD ) , comorbid attention-deficit/hyperactivity disorder ( ADHD ) is associated with greater severity of substance abuse , conduct problems , and worse treatment outcomes . Although many controlled trials have established the efficacy of psychostimulants , including pemoline , for ADHD in children and adolescents , none have been conducted in adolescents with SUD . This r and omized , placebo-controlled trial , conducted between 1996 and 2000 , evaluated the safety and efficacy of pemoline on substance abuse and conduct problems . METHOD Sixty-nine adolescents ( aged 13 - 19 ) with conduct disorder ( CD ) , SUD , and ADHD were recruited from the community and r and omly assigned to a 12-week clinical trial of pemoline ( n = 35 ) or placebo ( n = 34 ) , titrated over 4 weeks to a single morning dose of 75 to 112.5 mg as tolerated . RESULTS Pemoline had greater efficacy than placebo for ADHD as determined by significantly more Clinician 's Global Impression-Improvement ( CGI-I ) ratings of 1 ( very much improved ) or 2 ( much improved ) at the study endpoint ( n = 69 ; p < .05 ) . There was also greater reduction in ADHD severity on the parent-rated Conners Hyperactivity-Impulsivity scale in pemoline-treated study completers compared to placebo-treated completers ( pemoline , n = 17 ; placebo , n = 16 ; p < .01 ) , but no difference between groups in the intent-to-treat analysis ( n = 68 ; p < .13 ) . Substance use did not decline in either group , and there was no difference between groups in baseline to study endpoint change in substance use or CD symptoms . Overall , pemoline was well tolerated , demonstrating a good safety profile and no elevation in liver enzyme levels . CONCLUSIONS Pemoline was efficacious for ADHD but did not have an impact on CD or substance abuse in the absence of specific treatment for SUD BACKGROUND Few studies have investigated the comparative risk of neuroleptic-related dyskinesias in children and adolescents receiving typical versus newer , atypical antipsychotics .  This prospect i ve study was completed to test whether clinical use of atypical antipsychotics is associated with less risk for developing neuroleptic-related dyskinesias than clinical use of typical neuroleptics in an unselected heterogeneous population of seriously emotionally disturbed youths admitted to acute residential treatment . We also tested a novel model of predictive risk for neuroleptic-related dyskinesias in children and adolescents . METHOD 102 children and adolescents receiving typical neuroleptics , atypical antipsychotics , or the combination were studied . Youths developing neuroleptic-related dyskinesias were compared with youths free of dyskinesias over a 3-month study period on demographic , diagnostic , and treatment variables . Logistic regression was utilized to develop a novel model of predictive risk . RESULTS Of neuroleptic-treated youths , 5.9 % had probable tardive dyskinesia , a rate less than the prevalence of tardive dyskinesia in chronic neuroleptic-treated adults . Use of typical neuroleptics was significantly ( p = .03 ) associated with dyskinesia compared with use of atypical antipsychotics . Four variables including IQ , initial Abnormal Involuntary Movement Scale score , type of antipsychotic , and cumulative number of risk factors accounted for 35.8 % of the variance when predicting dyskinetic status . CONCLUSION Use of atypical antipsychotics appears to be associated with less dyskinesia risk than typical neuroleptics in an unselected group of seriously emotionally disturbed children and adolescents . Results support a cumulative risk model of neuroleptic-related dyskinesia in youths OBJECTIVE To assess the effect of methylpheni date on the diagnosis of oppositional-defiant disorder ( ODD ) comorbid with attention-deficit hyperactivity disorder ( ADHD ) . METHOD We conducted an open-label study in which 10 children and adolescents with a dual diagnosis of ODD and ADHD were assessed for their ODD symptoms and treated with methylpheni date . At least one month after ADHD symptoms were under control , ODD symptoms were reevaluated with the Parent form of the Children Interview for Psychiatric Syndromes ( P-ChIPS ) . RESULTS Nine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylpheni date for ADHD . CONCLUSION Methylpheni date seems to be an effective treatment for ODD , as well as for ADHD itself . The implication s for the treatment of patients with ODD not comorbid with ADHD needs further investigation OBJECTIVE Although the combination of methylpheni date ( MPH ) and behavior modification ( BMOD ) has been advocated to enhance clinical outcome for children with attention-deficit hyperactivity disorder ( ADHD ) and comorbid disruptive disorders , few group studies have been conducted . This study evaluates the separate and incremental effects of these modalities on rating scale and observational measures in multiple setting s. METHOD Sixteen of 22 children with ADHD and comorbid disruptive disorder completed a r and omized , placebo-controlled study examining the separate and incremental effects of 2 doses of MPH and BMOD during a partial hospitalization program . Of the 6 who did not complete the study , 2 children developed significant side effects . For the 16 who did complete the study , effects were examined on measures of symptom ratings , behavioral frequencies , and stimulant side effects across program activities . RESULTS Based on alpha-adjusted analyses of variance , there were several main effects of MPH and BMOD on ADHD symptoms , oppositional behavior , and positive social behavior , with certain effects unique to each intervention and setting . One incremental effect each was found for MPH ( positive mood/behavior ) and BMOD ( negative behavior ) . MPH and BMOD were associated with few side effects . Effect sizes for each intervention showed considerable variability in clinical response . CONCLUSIONS That MPH and BMOD had certain unique main and incremental effects extends findings supporting their combination and suggests that integrated studies evaluate multiple dimensions of functioning and in novel setting s ( e.g. , home , school ) . The incorporation of other intervention components in combined treatments may be warranted to enhance clinical efficacy OBJECTIVE To examine ( 1 ) moderating effects of oppositional defiant disorder ( ODD ) on attention-deficit/hyperactivity disorder ( ADHD ) treatment response and ( 2 ) responses of ODD symptoms to atomoxetine . METHOD Children and adolescents ( ages 8 - 18 ) with ADHD were treated for approximately 8 weeks with placebo or atomoxetine ( fixed dosing : 0.5 , 1.2 , or 1.8 mg/kg/day , b.i.d . ) under r and omized , double-blind conditions . Among patients with lifetime diagnostic information ( n = 293 ) , 39 % were diagnosed with comorbid ODD and 61 % were not . Treatment-group differences and differences between patients with and without comorbid ODD were examined post hoc for changes on the Attention-Deficit/Hyperactivity Disorder Rating Scale IV-Parent version , investigator-administered and -scored ; Conners ' Parent Rating Scale-Revised Short Form ; Clinical Global Impressions Severity of ADHD Scale ; and the parent-rated Child Health Question naire . RESULTS Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD , ODD , and quality -of-life measures . Treatment response was similar in youths with and without ODD , except that the comorbid group showed improvement compared with placebo at 1.8 mg/kg/day but not 1.2 mg/kg/day . In contrast , youths without ODD showed improvement at 1.2 mg/kg/day and no incremental benefit at 1.8 mg/kg/day . CONCLUSIONS Atomoxetine treatment improves ADHD and ODD symptoms in youths with ADHD and ODD , although the comorbid group may require higher doses A trial of haloperidol has been carried out with a group of 12 children with severe behaviour disorders in an in-patient unit . While on haloperidol the children were rated by the nurses as significantly less overactive , destructive , restless , and resentful , less aggressive with adults and less disobedient , than while on placebo . They were also rated as teasing and bullying other children less . Tests suggested that the drug had a slight , but significant , slowing effect OBJECTIVE This study was design ed to assess outpatient child psychiatrists ' prescribing practice s. METHOD Of 1,422 out patients in two public , university affiliated setting s in New York and Ohio , the charts of 146 medicated and 126 nonmedicated r and omly selected patients were review ed for demographic variables , DSM-III-R diagnoses , medications prescribed , and charted prescription rationale s. RESULTS Fifteen percent of the 800 out patients seen in a 1-month period in New York , and 19 % of the 626 out patients seen in a 1-year period in Ohio were prescribed medication . Patients medicated by clinic psychiatrists were significantly more likely than nonmedicated patients to be psychotic and to have been hospitalized previously , and significantly less likely to have adjustment disorder . Using st and ards employed by drug utilization review committees , medications were prescribed appropriately in approximately 90 % of cases . Of concern , 65 % of patients given antipsychotics in New York and 67 % in Ohio were not psychotic ; the primary target symptom in such cases was aggression . CONCLUSIONS Prescribing practice s appeared to be appropriate , although the use of antipsychotic medications in nonpsychotic children is a concern for the field of child psychiatry . The strong similarity of practice s in two independent and geographically remote sites suggests the findings are generalizable to providers in other public , university affiliated setting
target: Results There is some evidence of the effectiveness of medication in treating DBDs , with positive outcomes for lithium and risperidone in particular .
  Pharmacotherapy also demonstrated some efficacy in reducing symptoms of aggression .
  Medication was relatively well-tolerated , as indicated by equivalent dropout rates in medication and comparison groups .
background: Rationale Pharmacotherapy is frequently considered in the treatment of  disruptive behavior disorders ( DBDs ) in children and adolescents .
  There are , however , no systematic review s of this literature .
  Objectives The aim of this work is to determine whether medication is effective in treating pediatric disruptive behavior disorders and related problems of impulse control , as well as to examine differences in the treatment response and tolerability of different medication classes and agents .