New Research Demonstrates Benefits of Adding Risperidone to Standard Treatment of Severe Aggression for Some Children with ADHD

February 10, 2014 - New findings from a research team at Stony Brook University and colleagues at other medical centers confirm that in certain circumstances the addition of the antipsychotic drug risperidone to standard treatments can reduce physical aggression in children with attention-deficit/hyperactivity disorder (ADHD). Control of aggression is important not only because of its immediate effects, but because physically aggressive children are significantly more likely to experience social and psychological problems later in life.

In an article published in the Journal of the American Academy of Child & Adolescent Psychiatry, Kenneth Gadow, PhD; E. Victoria Rundberg-Rivera, MD and Joyce Sprafkin, PhD and their colleagues reported early results from the Treatment Of Severe Childhood Aggression (TOSCA) Study, a multi-year, multi-site project funded by the National Institute of Mental Health. One aim of the study is to determine if the benefits of prescribing an antipsychotic medication along with a stimulant to control aggression outweigh the risks. Although this form of augmented therapy has become a fact of life in child psychiatry, few controlled studies have been done to test its effectiveness.

The researchers randomly divided 168 children with ADHD with symptoms of severe physical aggression into two groups. Both groups received parental training and treatment with a stimulant. At the end of three weeks, the children who might benefit from further control of their aggressive symptoms were given either risperidone or a placebo in addition to the stimulant. At the end of nine weeks, both groups showed a marked reduction in their aggressive behaviors, but the group receiving risperidone displayed significantly less aggression and increased social competence than the group receiving placebo, as measured by parental rating scales. Rating scales completed by clinicians did not distinguish between the two groups, perhaps because parents were more sensitive to subtle changes in their children’s behavior than clinicians.

The article, titled “What Does Risperidone Add to Parent Training and Stimulant for Severe Aggression in Child Attention-Deficit/Hyperactivity Disorder?” was published in the January 2014 edition of the Journal of the American Academy of Child & Adolescent Psychiatry. Future articles will address longer-term findings from the study.

Drs. Gadow, Rundberg-Rivera and Sprafkin are members of the faculty of the Division of Child and Adolescent Psychiatry in the Department of Psychiatry at Stony Brook University. Michael G. Aman, PhD from The Ohio State University was the lead author.