Juvenile maladaptive aggression: a review of prevention, treatment, and service configuration and a proposed research agenda.
OBJECTIVE
To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry.


METHODS
Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies.


METHODS
Articles met the following criteria: published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance.


METHODS
Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed.


RESULTS
Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations.


CONCLUSIONS
Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.
Connor
Daniel F
DF
Department of Psychiatry/MC1410, University of Connecticut Health Center, Farmington 06030-1410, USA. connor@psychiatry.uchc.edu
Carlson
Gabrielle A
GA
Chang
Kiki D
KD
Daniolos
Peter T
PT
Ferziger
Reuven
R
Findling
Robert L
RL
Hutchinson
Janice G
JG
Malone
Richard P
RP
Halperin
Jeffrey M
JM
Plattner
Belinda
B
Post
Robert M
RM
Reynolds
Diane L
DL
Rogers
Kenneth M
KM
Saxena
Kirti
K
Steiner
Hans
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000374:Aggression / Q000187:drug effects / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D019955:Conduct Disorder / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy*; D005196:Family Therapy; D006801:Humans; D007604:Juvenile Delinquency / Q000517:prevention & control / Q000523:psychology; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods; D011613:Psychotherapy / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012107:Research Design; D012307:Risk Factors; D016896:Treatment Outcome; D014754:Violence / Q000517:prevention & control / Q000523:psychology
D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs