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Pharmacotherapy of disruptive behavior and item changes on a standardized rating scale: pooled analysis of
Michael Aman1, Jan Buitelaar, Goedele De Smedt
1The Nisonger Center, Ohio State University, Columbus, Ohio 4310, USA. aman.1@osu.edu
Insights
Risperidone improved social competence and problem behaviors in children with disruptive behavior disorders (DBDs). However, symptoms of affective insecurity and social disinterest were unaffected by the medication.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Science
- Pharmacology
Background:
- Disruptive behavior disorders (DBDs) involve persistent antisocial and aggressive behaviors violating age-appropriate norms.
- Risperidone is an approved medication for treating DBDs in various age groups.
- Assessing risperidone's efficacy on specific symptom items in DBD patients is crucial.
Purpose of the Study:
- To evaluate the clinical effect of risperidone on Nisonger Child Behavior Rating Form (N-CBRF) symptom items in children with DBDs.
- To determine which specific behavioral symptoms respond to risperidone treatment.
Main Methods:
- Pooled data from two 6-week, randomized, double-blind, placebo-controlled trials.
- Participants were children with DBDs and subaverage IQ (mild, moderate mental retardation, borderline IQ).
- Risperidone oral solution was administered at doses of 0.02-0.06 mg/kg/day.
Main Results:
- Risperidone significantly improved both Social Competence and Problem Behavior subscales of the N-CBRF.
- Symptom reduction was observed in Conduct Problem and Insecure/Anxious categories.
- Positive social behaviors improved, but 'affective insecurity' symptoms (e.g., shy, tearful) and social disinterest did not.
Conclusions:
- Risperidone effectively treats most problem behaviors in children with DBDs and subaverage IQ.
- Specific symptoms like 'affective insecurity' and social disinterest may not respond to risperidone.
- Findings offer a more nuanced understanding of risperidone's therapeutic profile in this population.
Background:
Disruptive behavior disorders (DBDs), excluding attention deficit/hyperactivity disorder (ADHD), are characterized by a repetitive pattern of antisocial, aggressive, and defiant behavior involving major violations of age-appropriate norms, resulting in significant functional impairment. Risperidone is licensed for the treatment of DBDs in children, adolescents, and adults in several countries. The aim of this study was to determine the effect of risperidone in a clinical setting on the symptom items of the Nisonger Child Behavior Rating Form (N-CBRF), used for the assessment of DBD patients.
Method:
Data from two 6-week, randomized, double-blind, placebo-controlled trials of risperidone oral solution (0.02-0.06 mg/kg/day) in children with DBDs and subaverage IQ (mild, moderate mental retardation and borderline IQ) were pooled for analysis.
Results:
Risperidone produced improvement in both the Social Competence and the Problem Behavior N-CBRF subscales. Risperidone reduced symptoms in the Problem Behavior subscales (e.g., Conduct Problem, Insecure/Anxious) but also improved positive behaviors on the Social Competence subscales. Unlike most problem-behavior items, certain items reflecting "Affective insecurity" (e.g., shy, timid; clings to adults; crying, tearful episodes) failed to improve. This was also true of social disinterest and certain rituals. No items showed any worsening of symptoms with active medication.
Conclusion:
Whereas most categories of problem behavior improved with risperidone, items reflecting "affective insecurity" and some infrequently endorsed items were unaffected in these children with DBDs and subaverage IQ. These data may provide a more refined knowledge of risperidone's therapeutic effects in such children.
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