title: Factors Associated with Management of Teen Aggression: Child Psychiatric Clinical Decision Making.
abstract: OBJECTIVE
  This study explores whether patient-specific and clinician-specific factors are associated with child psychiatrists' use of second generation antipsychotics (SGAs) in the management of aggression in children with attention-deficit/hyperactivity disorder (ADHD). The patient-specific factors included patient's race, caregiver status, and patient engagement in psychotherapy.
  
  
  METHODS
  Child psychiatrists attending an annual conference (n = 156) were asked to complete an anonymous questionnaire on clinical decision making. Each participant was randomized to one of eight vignettes on a physically aggressive male teenager with methylphenidate-responsive ADHD. Patient race, caregiving status, and patient engagement in psychotherapy were systematically varied. Respondents rated how likely they were to prescribe an SGA and whether they would adjust the patient's current medication.
  
  
  RESULTS
  Seventy-five percent of participants (n = 117) were uncomfortable with adding an SGA, and 61% (n = 95) were likely to make medication adjustments to the current stimulant. None of the patient-specific factors were related to management recommendations. However, inpatient psychiatrists compared with non-inpatient psychiatrists reported a higher likelihood of using antipsychotics (OR = 2.40, 95% CI [1.181, 4.879], p = 0.016). Midwestern psychiatrists compared with those from other regions also reported a higher likelihood of using antipsychotics (OR = 3.07, 95% CI [1.376, 6.857], p = 0.005). Academic psychiatrists compared with nonacademics were less likely to endorse making adjustments to the current medication regimen (OR = 0.49, 95% CI [0.860, 0.274], p = 0.013).
  
  
  CONCLUSIONS
  When presented with a hypothetical case, the vast majority of child psychiatrists surveyed advised that additional information was needed before adding an SGA. Many felt the need for more psychosocial information and greater clarity of possible comorbid diagnoses.
authors.affiliation: 1 Department of Psychiatry, Stanford University School of Medicine , Stanford, California.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mann
authors.affiliation: 2 Department of Statistics, The University of Chicago , Chicago, Illinois.
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.affiliation: 3 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago , Chicago, Illinois.
authors.forename: Karam
authors.initials: K
authors.lastname: Radwan
authors.affiliation: 4 Department of Psychiatry, Rush University Medical Center , Chicago, Illinois.
authors.forename: Niranjan S
authors.initials: NS
authors.lastname: Karnik
authors.affiliation: 3 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago , Chicago, Illinois.
authors.forename: Kate
authors.initials: K
authors.lastname: Keenan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000374:Aggression / Q000187:drug effects*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002665:Child Psychiatry / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: aggression; antipsychotic; decision-making; management