Comorbid symptomatology moderates response to risperidone, stimulant, and parent training in children with severe
Cristan A Farmer1, Nicole V Brown, Kenneth D Gadow
11 Department of Psychiatry, Ohio State University , Columbus, Ohio.
Insights
Parent and child traits influence treatment response in severe childhood aggression. Certain child characteristics may indicate faster response to augmented treatment, which generally shows equal effectiveness across the sample.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Science
- Pharmacological Treatments
Background:
- Severe childhood aggression poses significant challenges for families and clinicians.
- Attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders are common comorbidities.
- Previous research indicated augmented treatment (stimulant + parent training + risperidone) surpassed basic treatment (stimulant + parent training + placebo) for disruptive behaviors.
Purpose of the Study:
- To evaluate parent and child characteristics as predictors and moderators of treatment response in children with severe aggression.
- To identify specific factors influencing the effectiveness and speed of response to basic versus augmented treatment.
Main Methods:
- A 9-week trial involving 168 children with severe aggression, disruptive behavior disorder, and ADHD.
- Comparison of basic treatment (n=84) versus augmented treatment (n=84).
- Analysis of parent variables (income, education, family functioning, employment) and child variables (IQ, aggression type, comorbid symptomatology) using linear mixed models.
Main Results:
- Higher ADHD symptom severity and callous/unemotional traits predicted better overall outcome on disruptive behavior scores.
- Anger/irritability and mania symptoms moderated the speed of response, particularly in the augmented group.
- Maternal education moderated positive social behavior outcomes, with children of less educated mothers benefiting more from augmented treatment.
Conclusions:
- Augmented treatment appears to be equally effective across the sample for overall disruptive behavior reduction.
- Specific child characteristics, such as anger/irritability and ADHD severity, may predict the speed of response to augmented treatment.
- Findings suggest personalized treatment approaches may optimize outcomes for children with severe aggression.
Objective:
In this study, we evaluated parent and child characteristics as predictors and moderators of response in the four-site Treatment of Severe Childhood Aggression (TOSCA) study.
Methods:
A total of 168 children with severe aggression, disruptive behavior disorder, and attention-deficit/hyperactivity disorder (ADHD) were enrolled in a 9-week trial of basic treatment (n=84, stimulant+parent training+placebo) versus augmented treatment (n=84, stimulant+parent training+risperidone). In the initial report, augmented treatment surpassed basic treatment in reducing the primary outcome of disruptive behavior (D-Total) scores. In the current study, we evaluated parent (income, education, family functioning, employment) and child variables (intelligence quotient [IQ], aggression type, comorbid symptomatology) as predictors or moderators, using linear mixed models and the MacArthur guidelines.
Results:
Higher scores on ADHD symptom severity and callous/unemotional traits predicted better outcome on D-Total regardless of treatment assignment. Two moderators of D-Total were found: Higher anger/irritability symptoms and lower mania scores were associated with faster response, although not better overall effect at endpoint, in the augmented but not the basic group. Several variables moderated response on secondary outcomes (ADHD severity and prosocial behavior), and were characterized by faster response, although not better outcome, in the augmented but not in the basic group. Maternal education moderated outcome on the measure of positive social behavior; children of mothers with less education benefited more from augmented treatment relative to basic than those with more education.
Conclusion:
Although these findings require validation, they tentatively suggest that augmented treatment works equally well across the entire sample. Nevertheless, certain child characteristics may be useful indicators for the speed of response to augmented treatment.
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