title: Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy.
  
  
  METHODS
  We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes.
  
  
  RESULTS
  In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23).
  
  
  CONCLUSIONS
  Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.
authors.affiliation: University of Texas Health Science Center (HSC) at San Antonio; North Shore-Long Island Jewish (LIJ) Health System. Electronic address: blader@uthscsa.edu.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Blader
authors.forename: Steven R
authors.initials: SR
authors.lastname: Pliszka
authors.forename: Vivian
authors.initials: V
authors.lastname: Kafantaris
authors.forename: Carmel A
authors.initials: CA
authors.lastname: Foley
authors.forename: Judith A
authors.initials: JA
authors.lastname: Crowell
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Carlson
authors.forename: Colin L
authors.initials: CL
authors.lastname: Sauder
authors.forename: David M
authors.initials: DM
authors.lastname: Margulies
authors.forename: Christa
authors.initials: C
authors.lastname: Sinha
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sverd
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Matthews
authors.forename: Brigitte Y
authors.initials: BY
authors.lastname: Bailey
authors.forename: W Burleson
authors.initials: WB
authors.lastname: Daviss
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000187:drug effects* / Q000523:psychology; D000987:Antisocial Personality Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000494:pharmacology*; D002648:Child; D002985:Clinical Protocols; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D019955:Conduct Disorder / Q000178:diet therapy / Q000453:epidemiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005196:Family Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000494:pharmacology*; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: CNS stimulants; aggression; attention-deficit/hyperactivity disorder (ADHD); oppositional defiant disorder; psychopathy