title: Experts' recommendations for treating maladaptive aggression in youth.
abstract: BACKGROUND
  Psychiatric treatment for children and adolescents with clinically significant aggression is common and often involves the use of antipsychotic medications. Increasingly, pediatricians are initiating or managing such treatments despite limited evidence on optimal diagnostic, psychosocial, and medication approaches for pediatric aggression.
  
  
  OBJECTIVE
  The objective of this study was to gather clinicians' and researchers' expertise concerning the treatment of maladaptive aggression, using expert consensus survey methods to aid the development of guidelines for pediatricians and psychiatrists on the outpatient treatment of maladaptive aggression in youth (T-MAY).
  
  
  METHODS
  Forty-six experts (psychiatrists, pediatricians, and researchers) with >10 years of clinical and/or research experience in the treatment of pediatric aggression completed a 27-item survey (>400 treatment alternatives) about optimal diagnostic, psychosocial, and medication treatments. Data were analyzed using descriptive statistics and confidence intervals.
  
  
  RESULTS
  Expert consensus methodology clearly differentiated optimal versus nonoptimal treatment strategies for maladaptive aggression. In contrast to current practice trends, results indicated that experts support the use of psychosocial interventions and parent education and training before the use of medication for maladaptive aggression at every stage of medication treatment, from diagnosis to maintenance to medication discontinuation.
  
  
  CONCLUSIONS
  Overall findings indicate that evidence-informed strategies for outpatient treatment of pediatric maladaptive aggression, guided by systematically derived expert opinions, are attainable. In light of the gap between the research literature and clinical practice, expert consensus opinion supports specific practices for optimal outpatient management in children and adolescents with severe and persistent behavioral difficulties.
authors.affiliation: Center for the Advancement of Children's Mental Health, Columbia University, New York, New York, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pappadopulos
authors.forename: Nancy Scotto
authors.initials: NS
authors.lastname: Rosato
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Judith
authors.initials: J
authors.lastname: Lucas
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jensen
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000187:drug effects* / Q000523:psychology*; D002648:Child; D032921:Consensus; D003625:Data Collection; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs