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Risperidone augmentation for treatment-resistant aggression in attention-deficit/hyperactivity disorder: a
Jorge L Armenteros1, John E Lewis1, Marisabel Davalos1
1Dr. Armenteros is in private practice, Coral Gables, FL; and Dr. Lewis and Ms. Davalos are with the University of Miami Miller School of Medicine.
Summary
Risperidone augmentation modestly improved treatment-resistant aggression in children with ADHD when combined with psychostimulants. While parent-reported aggression decreased, teacher-reported aggression showed no significant change, with well-tolerated side effects.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Pharmacological Interventions
Background:
- Attention-deficit/hyperactivity disorder (ADHD) often presents with significant aggressive behaviors.
- Treatment resistance to standard therapies is a common challenge in managing ADHD-related aggression.
- Psychostimulant medications are a first-line treatment for ADHD but may not fully address aggression.
Purpose of the Study:
- To assess the efficacy and tolerability of risperidone as an add-on therapy for children with ADHD and treatment-resistant aggression.
- To evaluate the impact of risperidone on aggressive behaviors in this specific pediatric population.
- To compare the effects of risperidone versus placebo in children already receiving psychostimulant treatment.
Main Methods:
- A double-blind, randomized study involving 25 children (ages 7-12) with ADHD and aggression.
- Participants were maintained on a stable dose of psychostimulant medication.
- Treatment duration was 4 weeks, with efficacy measured by the Children's Aggression Scale-Parent (CAS-P) and -Teacher (CAS-T).
Main Results:
- Risperidone (mean dose 1.08 mg/day) showed a significant improvement in parent-reported aggression (CAS-P), with 100% of subjects showing >30% reduction from baseline.
- Only 77% of the placebo group achieved similar parent-reported improvement.
- No significant differences were observed in teacher-reported aggression (CAS-T) between risperidone and placebo groups.
- Adverse event rates were comparable between the risperidone and placebo groups.
Conclusions:
- Risperidone augmentation appears to be a well-tolerated option for managing treatment-resistant aggression in children with ADHD.
- The medication demonstrated modest efficacy, particularly in parent-reported outcomes, when used alongside psychostimulants.
- Further research may be needed to understand the differential effects on parent versus teacher-reported aggression.
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