Pharmacotherapy of disruptive behavior and item changes on a standardized rating scale: pooled analysis of risperidone effects in children with subaverage IQ.
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.


METHODS
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.


CONCLUSIONS
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.
Aman
Michael
M
The Nisonger Center, Ohio State University, Columbus, Ohio 4310, USA. aman.1@osu.edu
Buitelaar
Jan
J
Smedt
Goedele De
GD
Wapenaar
Robert
R
Binder
Carin
C
D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007360:Intelligence / Q000187:drug effects* / Q000502:physiology; D007361:Intelligence Tests / Q000706:statistics & numerical data*; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D018967:Risperidone / Q000494:pharmacology / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D018967:Risperidone