title: Prevalence and Treatment Outcomes of Persistent Negative Mood Among Children with Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior.
abstract: OBJECTIVE
  Diagnostic criteria for disruptive mood dysregulation disorder (DMDD) require 1) periodic rageful outbursts and 2) disturbed mood (anger or irritability) that persists most of the time in between outbursts. Stimulant monotherapy, methodically titrated, often culminates in remission of severe aggressive behavior, but it is unclear whether those with persistent mood symptoms benefit less.This study examined the association between the presence of persistent mood disturbances and treatment outcomes among children with attention-deficit/hyperactivity disorder (ADHD) and periodic aggressive, rageful outbursts.
  
  
  METHODS
  Within a cohort of children with ADHD and aggressive behavior (n = 156), the prevalence of persistent mood symptoms was evaluated at baseline and after completion of a treatment protocol that provided stimulant monotherapy and family-based behavioral treatment (duration mean [SD] = 70.04 [37.83] days). The relationship of persistent mood symptoms on posttreatment aggressive behavior was assessed, as well as changes in mood symptoms.
  
  
  RESULTS
  Aggressive behavior and periodic rageful outbursts remitted among 51% of the participants. Persistent mood symptoms at baseline did not affect the odds that aggressive behavior would remit during treatment. Reductions in symptoms of sustained mood disturbance accompanied reductions in periodic outbursts. Children who at baseline had high irritability but low depression ratings showed elevated aggression scores at baseline and after treatment; however, they still displayed large reductions in aggression.
  
  
  CONCLUSIONS
  Among aggressive children with ADHD, aggressive behaviors are just as likely to decrease following stimulant monotherapy and behavioral treatment among those with sustained mood symptoms and those without. Improvements in mood problems are evident as well. Therefore, the abnormalities in persistent mood described by DMDD's criteria do not contraindicate stimulant therapy as initial treatment among those with comorbid ADHD. Rather, substantial improvements may be anticipated, and remission of both behavioral and mood symptoms seems achievable for a proportion of patients.
  
  
  BACKGROUND
  ClinicalTrials.gov (U.S.); IDs: NCT00228046 and NCT00794625; www.clinicaltrials.gov.
authors.affiliation: 1 Department of Psychiatry, University of Texas Health Science Center at San Antonio , San Antonio, Texas.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Blader
authors.affiliation: 1 Department of Psychiatry, University of Texas Health Science Center at San Antonio , San Antonio, Texas.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Pliszka
authors.affiliation: 2 Department of Psychiatry Research, Zucker Hillside Hospital/North Shore-LIJ Health System , Glen Oaks, New York.
authors.forename: Vivian
authors.initials: V
authors.lastname: Kafantaris
authors.affiliation: 1 Department of Psychiatry, University of Texas Health Science Center at San Antonio , San Antonio, Texas.
authors.forename: Colin
authors.initials: C
authors.lastname: Sauder
authors.affiliation: 3 Department of Child Psychiatry, New York State Psychiatric Institute , New York, New York.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Posner
authors.affiliation: 2 Department of Psychiatry Research, Zucker Hillside Hospital/North Shore-LIJ Health System , Glen Oaks, New York.
authors.forename: Carmel A
authors.initials: CA
authors.lastname: Foley
authors.affiliation: 4 Department of Psychiatry, Stony Brook University, State University of New York , Stony Brook, New York.
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Carlson
authors.affiliation: 4 Department of Psychiatry, Stony Brook University, State University of New York , Stony Brook, New York.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Crowell
authors.affiliation: 4 Department of Psychiatry, Stony Brook University, State University of New York , Stony Brook, New York.
authors.forename: David M
authors.initials: DM
authors.lastname: Margulies
mesh_terms: D000293:Adolescent; D000374:Aggression; D001289:Attention Deficit Disorder with Hyperactivity / Q000503:physiopathology* / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants