Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: implications for medication studies.
OBJECTIVE
To determine whether impulsive aggression (IA) is a meaningful clinical construct and to ascertain whether it is sufficiently similar across diagnostic categories, such that parallel studies across disorders might constitute appropriate evidence for pursuing indications. If so, how should IA be assessed, pharmacological studies designed, and ethical issues addressed?


METHODS
Experts from key stakeholder communities, including academic clinicians, researchers, practicing clinicians, U.S. Food and Drug Administration, National Institute of Mental Health, industry sponsors, and patient and family advocates, met for a 2-day consensus conference on November 4 and 5, 2004. After evaluating summary presentations on current research evidence, participants were assigned to three workgroups, examined core issues, and generated consensus guidelines in their areas. Workgroup recommendations were discussed by the whole group to reach consensus, and then further iterated and condensed into this report postconference by the authors.


RESULTS
Conference participants agreed that IA is a substantial public health and clinical concern, constitutes a key therapeutic target across multiple disorders, and can be measured with sufficient precision that pharmacological studies are warranted. Additional areas of consensus concerned types of measures, optimal study designs, and ethical imperatives.


CONCLUSIONS
Derived from scientific evidence and clinical experience, these consensus-driven recommendations can guide the design of future studies.
Jensen
Peter S
PS
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred. Electronic address: pj131@columbia.edu.
Youngstrom
Eric A
EA
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Steiner
Hans
H
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Findling
Robert L
RL
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Meyer
Roger E
RE
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Malone
Richard P
RP
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Carlson
Gabrielle A
GA
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Coccaro
Emil F
EF
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Aman
Michael G
MG
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Blair
James
J
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Dougherty
Donald
D
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Ferris
Craig
C
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Flynn
Laurie
L
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Green
Evelyn
E
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Hoagwood
Kimberly
K
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Hutchinson
Janice
J
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Laughren
Tom
T
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Leve
Leslie D
LD
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Novins
Douglas K
DK
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
Vitiello
Benedetto
B
Dr. Vitiello's and Dr. Laughren's contributions to this article were made in their private capacity. No official support or endorsement by the National Institute of Mental Health or the U.S. Food and Drug Administration is intended nor should be inferred.
D000374:Aggression / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D001321:Autistic Disorder / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002665:Child Psychiatry / Q000379:methods*; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D004358:Drug Therapy / Q000379:methods*; D006801:Humans; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology