Individually Optimized Therapy Reduces ADHD Problems

Titrated stimulant monotherapy, behavior modification lower aggression
By Monica Smith
HealthDay Reporter

MONDAY, Sept. 13 (HealthDay News) -- Children with attention-deficit/hyperactivity disorder (ADHD), disruptive levels of aggression, and a history of insufficient response to stimulant medication may benefit from a protocol of individually optimized stimulant monotherapy and behavioral intervention, according to research published online Sept. 13 in Pediatrics.

Joseph C. Blader, Ph.D., of the State University of New York in Stony Brook, and colleagues analyzed 65 children, aged 6 to 13 years, with ADHD, aggressive behavior, a history of sub-par response to stimulants, and either oppositional defiant disorder or conduct disorder, concentrating on their response to a program of open stimulant monotherapy. Stimulant titration along with weekly behavior and tolerability assessments identified an optimal regimen for each child. Families received behavioral therapy as well.

The researchers found that aggression sufficiently lessened in 32 (49.3 percent) of the children after behavioral intervention and stimulant dosage adjustment. Children who responded to the stimulant monotherapy appeared to require lower dosages and fewer behavioral therapy sessions than children with stimulant-refractory aggression. Boys, especially those with greater affect-related disruptive behaviors, displayed stimulant-refractory aggression more often than girls.

"Among children whose aggressive behavior develops in the context of ADHD and of oppositional defiant disorder or conduct disorder, and who had insufficient response to previous stimulant treatment in routine clinical care, systematic, well-monitored titration of stimulant monotherapy often culminates in reduced aggression that averts the need for additional agents," the authors write.

Several authors disclosed financial relationships with pharmaceutical and/or medical device companies, including Abbott Laboratories, which partly funded the research.

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