Juvenile maladaptive aggression: a review of prevention, treatment, and service configuration and a proposed research agenda.

Full Abstract

OBJECTIVE:
To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry.

DATA SOURCES:
Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms:
aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies.

DATA EXTRACTION:
Articles met the following criteria:
published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance.

STUDY SELECTION:
Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed.

RESULTS:
Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations.

CONCLUSIONS:
Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.

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Author information

Author/s: Connor, Daniel F (DF); Carlson, Gabrielle A (GA); Chang, Kiki D (KD); Daniolos, Peter T (PT); Ferziger, Reuven (R); Findling, Robert L (RL); Hutchinson, Janice G (JG); Malone, Richard P (RP); Halperin, Jeffrey M (JM); Plattner, Belinda (B); Post, Robert M (RM); Reynolds, Diane L (DL); Rogers, Kenneth M (KM); Saxena, Kirti (K); Steiner, Hans (H); Stanford/Howard/AACAP Workgroup on Juvenile Impulsivity and Aggression;

Affiliation: Department of Psychiatry/MC1410, University of Connecticut Health Center, Farmington 06030-1410, USA. connor(-atsign-)psychiatry.uchc.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Review

Journal: The Journal of clinical psychiatry (J Clin Psychiatry), published in United States. (Language: eng)

Reference: 2006-May; vol 67 (issue 5) : pp 808-20

Dates: Created 2006/07/17; Completed 2006/08/02; Revised 2007/11/15;

PMID: 16841631, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent
Adult
Age Factors
Aggression - drug effects; psychology
Attention Deficit Disorder with Hyperactivity - prevention & control; psychology; therapy
Attention Deficit and Disruptive Behavior Disorders - prevention & control; psychology; therapy
Central Nervous System Stimulants - therapeutic use
Child
Child, Preschool
Clinical Protocols
Conduct Disorder - prevention & control; psychology; therapy

Family Therapy
Humans
Juvenile Delinquency - prevention & control; psychology
Patient Care Team - organization & administration
Patient Education as Topic - methods
Psychotherapy - methods
Psychotropic Drugs - therapeutic use
Research Design
Risk Factors
Treatment Outcome
Violence - prevention & control; psychology

Associated Chemicals: Central Nervous System Stimulants (0) ; Psychotropic Drugs (0)

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