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Training parents may reduce aggressive, disruptive behavior of children with ADHD

Teaching behavior management techniques to parents reduced aggressive and serious disruptive behavior among children with ADHD receiving stimulant and antipsychotic treatment, according to study findings in the Journal of Child and Adolescent Psychopharmacology.

Researchers randomized 168 children (aged 6 to 12 years) with severe aggression, disruptive behavior disorder and ADHD to receive parent training plus stimulant plus placebo or parent training plus stimulant plus an antipsychotic drug, risperidone, for 9 weeks. All participants received parent training plus stimulant from baseline to 3 weeks and then began the 6-week randomized treatment with risperidone or placebo.

“We wanted to see if we could expand or augment treatment by adding a second medication. So we added a placebo for the ‘basic group’ and added risperidone for the ‘augmented group,’ if there was room for improvement at the end of the third week,” study researcher Michael G. Aman, PhD, of Ohio State University, said in a press release.

Researchers collected behavior reports from parents and teachers of study participants.

Parent ratings had no significant effect on anxiety, depression, manic symptoms, schizophrenia spectrum disorder (SSD), eating disorders, autism symptoms or enuresis/encopresis.

Conversely, teacher ratings indicated significant improvement in anxiety, SSD and global impairment. Further, teacher ratings indicated the risperidone-augmentation mediated disruptive behavior through improvement of anxiety.

“The fact that significant findings were confined to teacher ratings, for which only 46 of the 168 children had data at both baseline and end-point (in contrast to 150 with parent data at both times), raised a question about possible bias in the subsample with both parent and teacher data,” the researchers wrote.

Nevertheless, the study findings suggest that parent training plus stimulant plus risperidone improves school-setting anxiety and social avoidance among children with severe aggression, disruptive behavior disorder and ADHD.

“Clinicians need to attend to both internal emotional and external behavioral symptoms in children presenting with blatant behavioral symptoms,” the researchers concluded. – by Amanda Oldt

Disclosure: Arnold reports financial ties with Biomarin, CureMark, Forest, Gowlings, Lilly, Novartis, Noven, Otsuka, Pfizer, Roche, Seaside Therapeutics, Shire and Tris Pharma. Please see the full study for a list of all other authors’ relevant financial disclosures.