Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 8704565 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-5418 (Electronic) Linking ISSN: 08908567 NLM ISO Abbreviation: J Am Acad Child Adolesc Psychiatry Subsets: MEDLINE
    • Publication Information:
      Publication: Jan. 2010- : New York : Elsevier
      Original Publication: [Baltimore, Md.] : The Academy, [1987-
    • Subject Terms:
      Aggression/*drug effects ; Antisocial Personality Disorder/*drug therapy ; Attention Deficit and Disruptive Behavior Disorders/*drug therapy ; Central Nervous System Stimulants/*pharmacology ; Methylphenidate/*pharmacology; Adolescent ; Aggression/psychology ; Antisocial Personality Disorder/epidemiology ; Antisocial Personality Disorder/physiopathology ; Attention Deficit Disorder with Hyperactivity/drug therapy ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Attention Deficit Disorder with Hyperactivity/physiopathology ; Attention Deficit and Disruptive Behavior Disorders/epidemiology ; Attention Deficit and Disruptive Behavior Disorders/physiopathology ; Central Nervous System Stimulants/administration & dosage ; Child ; Clinical Protocols ; Cohort Studies ; Combined Modality Therapy ; Comorbidity ; Conduct Disorder/diet therapy ; Conduct Disorder/epidemiology ; Conduct Disorder/physiopathology ; Dose-Response Relationship, Drug ; Family Therapy/methods ; Female ; Humans ; Male ; Methylphenidate/administration & dosage ; Psychiatric Status Rating Scales ; Remission Induction ; Severity of Illness Index ; Treatment Outcome
    • Abstract:
      Objective: Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy.
      Method: We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes.
      Results: In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23).
      Conclusions: Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.
      (Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: J Am Acad Child Adolesc Psychiatry. 2013 Dec;52(12):1257-9. (PMID: 24290458)
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    • Grant Information:
      K23MH064975 United States MH NIMH NIH HHS; M01 RR018535 United States RR NCRR NIH HHS; M01RR018535 United States RR NCRR NIH HHS; MO1RR10710 United States RR NCRR NIH HHS; K23 MH064975 United States MH NIMH NIH HHS; M01 RR010710 United States RR NCRR NIH HHS; R01 MH080050 United States MH NIMH NIH HHS; R01MH080050 United States MH NIMH NIH HHS
    • Contributed Indexing:
      Keywords: CNS stimulants; aggression; attention-deficit/hyperactivity disorder (ADHD); oppositional defiant disorder; psychopathy
    • Molecular Sequence:
      ClinicalTrials.gov NCT00228046; NCT00794625
    • Accession Number:
      0 (Central Nervous System Stimulants)
      207ZZ9QZ49 (Methylphenidate)
    • Publication Date:
      Date Created: 20131203 Date Completed: 20151023 Latest Revision: 20211021
    • Publication Date:
      20231215
    • Accession Number:
      PMC4530123
    • Accession Number:
      10.1016/j.jaac.2013.08.024
    • Accession Number:
      24290461