title: Comorbid symptomatology moderates response to risperidone, stimulant, and parent training in children with severe aggression, disruptive behavior disorder, and attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  In this study, we evaluated parent and child characteristics as predictors and moderators of response in the four-site Treatment of Severe Childhood Aggression (TOSCA) study.
  
  
  METHODS
  A total of 168 children with severe aggression, disruptive behavior disorder, and attention-deficit/hyperactivity disorder (ADHD) were enrolled in a 9-week trial of basic treatment (n=84, stimulant+parent training+placebo) versus augmented treatment (n=84, stimulant+parent training+risperidone). In the initial report, augmented treatment surpassed basic treatment in reducing the primary outcome of disruptive behavior (D-Total) scores. In the current study, we evaluated parent (income, education, family functioning, employment) and child variables (intelligence quotient [IQ], aggression type, comorbid symptomatology) as predictors or moderators, using linear mixed models and the MacArthur guidelines.
  
  
  RESULTS
  Higher scores on ADHD symptom severity and callous/unemotional traits predicted better outcome on D-Total regardless of treatment assignment. Two moderators of D-Total were found: Higher anger/irritability symptoms and lower mania scores were associated with faster response, although not better overall effect at endpoint, in the augmented but not the basic group. Several variables moderated response on secondary outcomes (ADHD severity and prosocial behavior), and were characterized by faster response, although not better outcome, in the augmented but not in the basic group. Maternal education moderated outcome on the measure of positive social behavior; children of mothers with less education benefited more from augmented treatment relative to basic than those with more education.
  
  
  CONCLUSIONS
  Although these findings require validation, they tentatively suggest that augmented treatment works equally well across the entire sample. Nevertheless, certain child characteristics may be useful indicators for the speed of response to augmented treatment.
authors.affiliation: 1 Department of Psychiatry, Ohio State University , Columbus, Ohio.
authors.forename: Cristan A
authors.initials: CA
authors.lastname: Farmer
authors.forename: Nicole V
authors.initials: NV
authors.lastname: Brown
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Gadow
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.forename: David G
authors.initials: DG
authors.lastname: Kolko
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Brooke S G
authors.initials: BS
authors.lastname: Molina
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Buchan-Page
authors.forename: Robert R
authors.initials: RR
authors.lastname: Rice
authors.forename: Srihari S
authors.initials: SS
authors.lastname: Bangalore
authors.forename: Oscar
authors.initials: O
authors.lastname: Bukstein
authors.forename: E Victoria
authors.initials: EV
authors.lastname: Rundberg-Rivera
authors.forename: Nora
authors.initials: N
authors.lastname: McNamara
authors.forename: Michael G
authors.initials: MG
authors.lastname: Aman
mesh_terms: D000374:Aggression / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education; D018967:Risperidone / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012919:Social Behavior; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D018967:Risperidone