title: Risperidone added to parent training and stimulant medication: effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression.
abstract: OBJECTIVE
  In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication, and placebo (Basic therapy) versus parent training, stimulant, and risperidone (Augmented therapy) by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced impairment, and informant discrepancy.
  
  
  METHODS
  Children (6-12 years of age; N = 168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks.
  
  
  RESULTS
  Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p = .002, Cohen's d = 0.27) and peer aggression (p = .02, Cohen's d = 0.32) but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at week 9/endpoint (p = .008). Teacher ratings indicated greater reduction in ADHD severity (p = .02, Cohen's d = 0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated as impaired for at least 1 targeted disorder at week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%).
  
  
  CONCLUSIONS
  Augmented therapy was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context specific, and effect sizes ranged from small to moderate. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov/; NCT00796302.
authors.affiliation: Stony Brook University, Stony Brook, NY. Electronic address: kenneth.gadow@stonybrook.edu.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Gadow
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: University of Pittsburgh School of Medicine.
authors.forename: Brooke S G
authors.initials: BS
authors.lastname: Molina
authors.affiliation: Johns Hopkins University and the Kennedy Krieger Institute, Baltimore.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.affiliation: University of Texas-Houston Medical School.
authors.forename: Oscar G
authors.initials: OG
authors.lastname: Bukstein
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Nicole V
authors.initials: NV
authors.lastname: Brown
authors.affiliation: Case Western Reserve University, Cleveland.
authors.forename: Nora K
authors.initials: NK
authors.lastname: McNamara
authors.affiliation: Stony Brook University, Stony Brook, NY.
authors.forename: E Victoria
authors.initials: EV
authors.lastname: Rundberg-Rivera
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Xiaobai
authors.initials: X
authors.lastname: Li
authors.affiliation: University of Pittsburgh School of Medicine.
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Kipp
authors.affiliation: Stony Brook University, Stony Brook, NY.
authors.forename: Jayne
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Ohio State University, Columbus, OH; National Institute of Mental Health.
authors.forename: Cristan A
authors.initials: CA
authors.lastname: Farmer
authors.affiliation: Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Baker
authors.affiliation: Stony Brook University, Stony Brook, NY.
authors.forename: Joyce
authors.initials: J
authors.lastname: Sprafkin
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Rice
authors.affiliation: University of Pittsburgh School of Medicine.
authors.forename: Srihari S
authors.initials: SS
authors.lastname: Bangalore
authors.affiliation: Nationwide Children's Hospital of Columbus.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Butter
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Buchan-Page
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hurt
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Adrienne B
authors.initials: AB
authors.lastname: Austin
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Sabrina N
authors.initials: SN
authors.lastname: Grondhuis
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Aman
mesh_terms: D000374:Aggression / Q000187:drug effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000494:pharmacology*; D002648:Child; D003131:Combined Modality Therapy; D019955:Conduct Disorder / Q000188:drug therapy / Q000628:therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education*; D010379:Peer Group; D018967:Risperidone / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D018967:Risperidone
keywords: ADHD; aggression; multiple drug therapy; risperidone; stimulant drug