title: Predictive familial risk factors and pharmacological responses in ADHD with comorbid disruptive behavior disorders.
abstract: BACKGROUND
  The aim of the present study was to examine the putative familial risk factors and evaluate the pharmacological effects in children and adolescents of attention-deficit-hyperactivity disorder (ADHD) with comorbid disruptive behavior disorders (DBD) and normal IQ.
  
  
  METHODS
  The retrospective study included 144 Japanese subjects (age, 5-18 years) with ADHD, of whom 35 subjects (24%) met the diagnostic criteria for DBD. Using multiple regression analysis, the familial background risk factors that might increase any comorbid antisocial behaviors were assessed. Furthermore, the 20 methylphenidate (MPH)-resistant DBD subjects were divided into three treatment groups: MPH plus risperidone (n= 8); MPH plus carbamazepine (n= 5); and MPH plus lithium carbonate (n= 4). The effectiveness of the treatment was evaluated both before and after the add-on therapy using the Clinical Global Impressions-Improvement (CGI-I) and CGI-Severity (CGI-S) scale.
  
  
  RESULTS
  The putative familial risk factors were child abuse (odds ratio [OR], 19.48; P= 0.013) and maternal psychiatric disorders (OR, 15.59; P= 0.027). The addition of risperidone had the strongest tendency to improve the CGI-S score (P= 0.063) and the highest rate of responses (50%) among the three treatment groups, albeit with no significant differences. Very few remarkable adverse clinical symptoms were observed.
  
  
  CONCLUSIONS
  Child abuse and maternal psychiatric disorders are suggested to be significant risk factors in influencing the development of comorbid DBD in offspring. The use of risperidone appears to be well tolerated and is moderately effective in MPH-resistant aggression in ADHD children and adolescents with comorbid DBD.
authors.affiliation: Department of Psychiatry, National Hospital Organization, Kagawa Children's Hospital, Kagawa, Japan. n-bando@kagawasyoni.hosp.go.jp
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Bandou
authors.forename: Kayoko
authors.initials: K
authors.lastname: Koike
authors.forename: Hideo
authors.initials: H
authors.lastname: Matuura
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005195:Family Relations; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D016015:Logistic Models; D008297:Male; D009034:Mother-Child Relations; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018967:Risperidone / Q000008:administration & dosage*; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome
chemical_list: D018967:Risperidone