title: Combined pharmacotherapy-multimodal psychotherapy in children with Disruptive Behavior Disorders.
abstract: Although multi-component psychotherapeutic interventions are first-line treatments for Disruptive Behavior Disorders (DBD), pharmacotherapy is often associated for more severe patients. Our aim was to explore effectiveness of an associated pharmacotherapy in referred children with DBD receiving a one-year psychotherapeutic intervention. Aggression, callous unemotional (CU) traits and emotional dysregulation were outcome measures. The sample included 144 children, aged 8-12 years, 41 (29%) with an ADHD comorbidity. Fifty-five (38%) patients received an additional pharmacotherapy with one medication, methylphenidate, a second generation antipsychotic, or a mood stabilizer. Data were collected before and after the one-year treatment. According to the Child Behavior Checklist (CBCL), aggressive behaviors, rule-breaking behaviors and emotional dysregulation improved in the whole group, as well as parent- and child-reported CU traits. The hierarchical regression model showed that additional pharmacotherapy significantly predicted lower scores at the CBCL aggressive behaviors and emotional dysregulation, but not CU traits at the end of the treatment. The interaction between methylphenidate and ADHD comorbidity predicted lower aggressive behaviors after the treatment. In summary, this naturalistic investigation suggest that an additional pharmacotherapy significantly improved aggression and emotional dysregulation, but not CU traits. When ADHD was comorbid, methylphenidate was more effective than antipsychotics or mood stabilizers in reducing aggression.
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy. Electronic address: gabriele.masi@fsm.unipi.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Milone
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
authors.forename: Azzurra
authors.initials: A
authors.lastname: Manfredi
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Brovedani
authors.affiliation: Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division, Second University of Naples, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Pisano
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Muratori
mesh_terms: D000374:Aggression / Q000187:drug effects / Q000523:psychology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology / Q000628:therapy; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000523:psychology / Q000628:therapy*; D057189:Checklist; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D015897:Comorbidity; D004644:Emotions / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D010290:Parents; D011613:Psychotherapy / Q000379:methods*
chemical_list: D014150:Antipsychotic Agents; D008774:Methylphenidate
keywords: Antipsychotics; Attention deficit hyperactivity disorder; Conduct disorder; Mood stabilizers; Stimulants