Co-morbid disruptive behavior disorder and aggression predict functional outcomes and differential response to risperidone versus divalproex in pharmacotherapy for pediatric bipolar disorder. Impact of providing psychiatry specialty pharmacist intervention on reducing drug‐related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open‐label study Drugs in aggressive behavior. Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. Preventive effects of treatment of disruptive behavior disorder in middle childhood on substance use and delinquent behavior. Impact of treatments for depression on comorbid anxiety, attentional, and behavioral symptoms in adolescents with selective serotonin reuptake inhibitor-resistant depression. Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder. Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. Intervention to improve compliance with pediatric anticonvulsant therapy. Feasibility of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents with Multi-Problems: Training, Adherence, and Retention One-year follow-up of pharmacotherapy-resistant patients with panic disorder treated with cognitive-behavior therapy: Outcome and predictors of remission. Treating disruptive behavior disorders with risperidone: a 1-year, open-label safety study in children and adolescents. Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence
OBJECTIVE Co-morbid diagnoses , such as disruptive behavior disorders ( DBDs ) and high levels of aggression , are extremely common among youth with pediatric bipolar disorder ( PBD ) and may interfere with treatment response ; however , they have rarely been examined as predictors of response to pharmacotherapy . The current study examines co-morbid DBD and aggression prospect ively as predictors of pharmacotherapy outcome , as well as potential moderators of response to a specific medication ( risperidone vs. divalproex ) , among children with PBD . METHODS Data are from a prospect i ve 6-week double-blind , placebo-controlled , r and omized outpatient medication treatment trial of risperidone versus divalproex for manic episodes in 65 children 8 - 18 with PBD . Outcome measures were administered at pretest , post-test , and weekly during the 6 weeks of treatment . Mixed-effects regression models were used to examine pharmacotherapy response . RESULTS Results indicated that youth with co-morbid DBD experienced greater improvement in manic symptoms in response to risperidone versus divalproex , whereas youth with non-co-morbid DBD experienced similar trajectories of symptom improvement in both medication groups . In addition , the non-DBD group experienced greater improvement in global functioning over time as compared with youth with co-morbid-DBD , and this gap increased over the course of treatment . Results also indicated that high-aggression youth experienced worse global functioning by end treatment versus low-aggression youth . CONCLUSIONS In conclusion , a co-morbid diagnosis of DBD and /or high levels of aggressive symptoms in youth with PBD may be important clinical predictors of variation in treatment response to pharmacotherapy . These findings may help research ers and clinicians develop tailored treatment approaches that optimize symptom and functional outcomes WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient 's function and quality of life . Due to the complicated neurobiological aetiology of autism spectrum disorder ( ASD ) , a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population . We evaluate the impact of providing specialty psychiatry ( PS ) pharmacist intervention in identifying and resolving drug-related problems ( DRPs ) among children with ASD associated with disruptive behaviours . METHODS An eight-week-long , prospect i ve , r and omized open-label study was conducted . Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included . They were r and omly assigned to an intervention or a control group . Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist , while those in control group were cared by a hospital pharmacist . The primary outcome was the number of patients who resolved of at least one DRP by the end of the study . The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability ( ABC-I ) scores between the two groups . RESULTS Twenty-five patients were r and omly assigned to either an intervention or control group . At week 8 , the total number of patients who resolved of at least one DRP was 13 ( 52 % ) in the intervention group and 4 ( 16 % ) in the control group , respectively ( P=.016 ) . Improper drug selection , medication non-adherence and subtherapeutic dosage were the most common DRPs . Mean ABC-I scores improved in the intervention group more than in the control group ( 9.8±5.6 vs 17.7±7.9 ; P<.001 ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD . The reduction in common DRPs mostly result ed from the PS pharmacist interventions , including selection of antipsychotic agent , adjustment of dosage based on ABC-I scores and provision of individualized drug counselling . Reducing DRPs led to the improvement of any disruptive behaviour . In addition , multidisciplinary team should develop drug therapy protocol s to promote the role of pharmacists in this setting The role of pharmacotherapy in the management of  severe aggressive behavior in children is review ed . An overview of the relevant literature , a discussion of method ological issues , and a description of a pilot study of the comparative efficacy of lithium , haloperidol , and chlorpromazine are presented . It is concluded that this area has not been studied systematic ally and that , in the future , research must be directed toward assessing the value of current and new pharmacological agents by using well-defined patient population s and attempting to identify subgroups of responders and nonresponders . Equally important are studies concerned with an evaluation of pharmacotherapy combined with psychosocial treatments . Lithium and haloperidol appear worthy of critical examination as adjuncts in the treatment of children for whom the long-term prognosis is poor . Journal of the American Academy of Child Psychiatry , 21 , 2:107–117 , 1982 OBJECTIVE The aim of this study was to examine the safety and efficacy of risperidone , with or without concomitant psychostimulant use , in the treatment of children with conduct disorder ( CD ) or other disruptive behavior disorders [ oppositional defiant disorder ( ODD ) , disruptive behavior disorder-not otherwise specified ( DBD-NOS ) ] , and comorbid attention-deficit hyperactivity disorder ( ADHD ) . METHODS Data from two 6-week placebo-controlled trials assessing risperidone therapy in children with subaverage IQs and CD , ODD , DBD-NOS were combined , and patients with comorbid ADHD were selected for this post hoc analysis . Patients were grouped according to r and omized drug therapy ( risperidone or placebo ) , and then subgrouped according to their use of a concomitant psychostimulant .  Safety outcomes included adverse events and weight change , while efficacy outcomes included changes in scores on disruptive behavior and hyperactivity-based subscales of two behavior-rating instruments ( Nisonger Child Behavior Rating Form and the Aberrant Behavior Checklist ) . RESULTS The analysis included 155 of 208 originally tested children divided into four sub-groups ( 35 - 43 patients each ) . There was no significant difference in the frequency of adverse events in patients who received  risperidone  alone and those who received risperidone plus a stimulant . The most common adverse events in risperidone-treated patients were somnolence , headache , dyspepsia , rhinitis , and vomiting . Within each r and omized treatment group , actual weight gain was comparable , regardless of concomitant stimulant use . Risperidone-treated patients had clinical ly and statistically significant reductions in both disruptive behavior and hyperactivity subscale scores , compared to placebo , regardless of concomitant stimulant use . The addition of risperidone to a psychostimulant result ed in significantly better control of hyperactivity ( p < 0.001 ) than was achieved with stimulant treatment alone , without causing an increase in adverse events . CONCLUSION Risperidone was a safe and effective treatment , with or without a combined psychostimulant , for both disruptive behavior disorders and comorbid ADHD in children OBJECTIVE Disruptive behavior disorder ( DBD ) is a well-known risk factor for substance abuse and delinquent behavior in adolescence . Therefore , the long-term preventive effects of treatment of DBD in middle childhood on beginning substance use and delinquency in early adolescence were investigated . METHOD Children with DBD ( 8 - 13 years old ) had been r and omly assigned to manualized behavior therapy ( Utrecht Coping Power Program ; UCPP )  or to care as usual ( CU ) in the Netherl and s. Five years ( 2003 - 2005 ) after the start of treatment ( 1996 - 1999 ) , substance use and delinquency were monitored in 61 of the initial 77 adolescents and compared with a matched healthy control group by means of self-report question naires . One-factor analyses of variance and Pearson 's chi2 analyses were performed . RESULTS Differences in substance use were revealed in favor of the UCPP , with more adolescents in the CU group smoking cigarettes in the last month ( UCPP 17 % , CU 42 % ; chi2 = 4.7 ; p < .03 ) and more adolescents in the CU group having ever used marijuana ( UCPP 13 % , CU 35 % ; chi2 = 4.0 ; p < .045 ) . Moreover , in this respect , the UCPP fit in the range of the matched healthy control group . Both treatment groups were comparable to the matched healthy control group in delinquent behavior . CONCLUSIONS Manualized behavior therapy for DBD in middle childhood seems to be more powerful than CU in reducing substance use in early adolescence . Both treatment conditions show a beneficial long-term preventive effect on delinquency OBJECTIVE To assess the relative efficacy of antidepressant medication , alone and in combination with cognitive behavioral therapy ( CBT ) , on comorbid symptoms of anxiety , attention , and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents ( TORDIA ) trial . METHOD Adolescents with selective serotonin reuptake inhibitor (SSRI)-resistant depression ( N = 334 ) were r and omly assigned to a medication switch alone ( to another SSRI or to venlafaxine ) or to a medication switch plus CBT .  Anxiety , attention-deficit/hyperactivity disorder ( ADHD ) , and disruptive behavior disorder ( DBD ) symptoms were assessed by psychiatric interview and self-report at regular intervals between baseline and 24 weeks . The differential effects of medication and of CBT , and the impact of remission on the course of comorbid symptoms and diagnoses , were assessed using generalized linear mixed models . RESULTS Remission was associated with a greater reduction in scalar measures of anxiety , ADHD , and DBDs , and a greater decrease in the rate of diagnosed anxiety disorders . The correlations between the changes in symptoms of depression on the CDRS-R and anxiety , ADHD , and oppositional symptoms were modest , ranging from r = 0.12 to r = 0.28 . There were no significant differential treatment effects on diagnoses , or corresponding symptoms . CONCLUSION The achievement of remission had a beneficial effect on anxiety , ADHD , and DBD symptoms , regardless of the type of treatment received . There were no differential effects of medication or CBT on outcome , except for a nonsignificant trend that those adolescents treated with SSRIs showed a greater decrease in rates of comorbid DBDs relative to those treated with venlafaxine . Clinical trial registration information-Treatment of SSRI-Resistant Depression In Adolescents ( TORDIA ) ; http:// clinical trials.gov/ ; NCT00018902 OBJECTIVE Multifamily psychoeducational psychotherapy ( MF-PEP ) is an efficacious treatment for children with mood disorders . Given the comorbidity between disruptive behaviors and mood disorders , this study examined associations between disruptive behaviors and impairment , impact of MF-PEP on disruptive behaviors , and whether disruptive behaviors affected treatment response of mood symptoms . METHOD Secondary analyses examined a r and omized controlled trial of MF-PEP versus waitlist control  ( N = 165 children 8 - 11 years old with mood disorders and their parents ) . Comorbid behavioral diagnoses occurred in 97 % of children . All participants continued treatment as usual . RESULTS Greater degree of disruptive behaviors was associated with worse mood symptoms and impairment . Between-group analyses examining outcome of disruptive behaviors were nonsignificant . Within-group analyses and between-group effect sizes suggested that MF-PEP was associated with decreases in attention-deficit/hyperactivity disorder ( d = 0.39 ) , oppositional defiant disorder ( d = 0.30 ) , and overall disruptive behavior symptoms ( d = 0.30 ) , but not conduct disorder symptoms . Baseline severity of disruptive behaviors did not affect treatment response of mood symptoms to MF-PEP . CONCLUSIONS MF-PEP is an effective intervention for children with mood disorders and provides some benefit for disruptive behaviors . Given that disruptive behavior severity does not affect children 's ability to experience improved mood symptoms , MF-PEP may be an important early intervention for children with comorbid mood and disruptive behavior disorders . Subsequent intervention targeting behavioral symptoms after improvement in mood may be beneficial . Studies examining treatment sequencing for children with comorbid mood and disruptive behavior disorders are needed . Clinical trial registration information-Family psychoeducation for children with mood disorders ; http:// clinical trials.gov ; NCT00050557 INTRODUCTION Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylpheni date preparation ( Medikinet retard , MPH-MR ) , with equal portions of the immediate-release and the sustained-release active substance , and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology . METHODS Eighty five children and adolescents ( 6 - 16 years ) were investigated in a double-blind , r and omized , clinical trial over 5 weeks under a treatment with MPH-MR  using symptom checklists for ADHD , oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) . RESULTS A total of 64.9 % of the children showed oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms . A statistically significant effect was found in the group treated with MPH ( verum-group ) . On the basis of Cohen 's criteria , high effects were found for aggressive symptoms in school ( d = 1.0 ) , but not in the afternoon ( d = 0.4 ) . There were also lower effect sizes for more severe aggressive symptoms . We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention . CONCLUSIONS Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior , especially concerning milder symptoms . The expected correlation between impulsivity and aggressiveness could be confirmed OBJECTIVE The objective of this study was to investigate the long-term safety and efficacy of risperidone in disruptive behavior disorders in children with subaverage IQs . Disruptive behavior disorders were defined as oppositional defiant disorder , disruptive behavior disorder , and conduct disorder as per the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria . METHODS This was a 48-week open-label ( OL ) extension study of risperidone in 77 children diagnosed with a disruptive behavior disorder , and either borderline intellectual function or mild or moderate mental retardation who had participated in a previous 6-week , double-blind ( DB ) study and completed at least 2 weeks of DB therapy . Children , aged 5 to 12 years inclusive , who had : 1 ) a DSM-IV Axis I diagnosis of conduct disorder , oppositional defiant disorder , or disruptive behavior disorder- not otherwise specified ; 2 ) a parent-assessed rating of > or = 24 in the Conduct Problem Subscale of the Nisonger-Child Behavior Rating Form(28 ) ; 3 ) a DSM-IV Axis II diagnosis of mild or moderate mental retardation or borderline intellectual functioning with an IQ > or = 36 and < or = 84 ; and 4 ) a score of < or = 84 on the Vinel and Adaptive Behavior Scale . Participants received oral solution risperidone given at a once daily dose of between 0.02 and 0.06 mg/kg for a maximum of 48 weeks . Participants in the DB study who had been r and omized would have had a maximum of 54 weeks of risperidone therapy . Study visits were scheduled at entry , weekly for the first month , and monthly for the remaining 11 months . RESULTS Baseline scores on the conduct problem subscale at the start of the previous DB study were similar for both treatment groups : mean values of 33.5 and 33.3 were recorded for placebo- and risperidone-treated participants , respectively . At the time of the OL baseline visit , mean Conduct Problem Subscale scores were lower in those who had been treated with risperidone than in those who remained risperidone-naïve ( 17.5 and 26.1 , respectively ) . Within 1 week of receiving daily risperidone therapy ( mean daily dose : 1.38 mg ) , those participants who had been risperidone-naïve at OL entry showed a rapid improvement in the Conduct Problem Subscale score . At the week 1 assessment , the mean change from baseline for those who had been risperidone-naïve at OL entry was similar in magnitude to the change from DB baseline recorded for participants who had received risperidone in the DB study . This mean improvement was sustained in both groups throughout the remainder of the OL study . At study endpoint , those participants who had been risperidone-naïve at OL entry experienced a highly significant mean decrease from OL baseline in the mean Conduct Problem Subscale score of 10.6 + /- 2.18 . The response to risperidone in the OL trial remained stable in those participants who had been treated with risperidone in the previous DB trial ; in this group , the mean change at study endpoint from OL baseline was a nonsignificant decrease of 1.26 + /- 1.45 . At DB baseline , 68 % of participants had a Clinical Global Impression assessment rated as marked , severe , or extremely severe . By DB study endpoint , only 17 % of participants ( 15 % of whom had received placebo and 19 % of whom had been treated with risperidone in the previous study ) had this severe an assessment ; 63 % of participants had symptoms rated as either none , very mild , or mild . Similarly , highly significant decreases from baseline in the Vinel and Adaptive Behavior Scale rating of the most troublesome symptom ( often identified as either aggression ( hitting , fighting , or temper tantrums ) were observed by study endpoint after 48 weeks of risperidone therapy . For those participants who had received placebo in the previous study , a mean decrease of 47.1 + /- 4.87 mm from a DB baseline of 79.4 + /- 2.69 mm was observed . In those who had received risperidone , a mean decrease of 43.5 + /- 4.57 mm from a DB baseline of 79.3 + /- 3.66 mm was observed . Five subgroup analyses of the primary efficacy outcome were performed . These included analysis by diagnosis ( conduct disorder , oppositional defiant disorder , and disruptive behavior disorder-not otherwise specified ) , degree of mental retardation ( borderline , mild , moderate ) , and presence or absence of somnolence , attention-deficit/hyperactivity disorder , and psychostimulants . The results showed that the efficacy of risperidone was not affected by type of disorder , level of retardation , presence/absence of somnolence or attention-deficit/hyperactivity disorder , or use of psychostimulants . Adverse events  were reported for 76 participants ; none were serious and most were mild/moderate in severity . Somnolence ( 52 % ) , headache ( 38 % ) , and weight gain ( 36 % ) were the most common adverse events . The degree of sedation was mild and not associated with cognitive deterioration . In fact , for most parameters assessed on the modified California Verbal Learning Test ( a test for verbal learning and memory ) , there were statistically significant improvements relative to both OL and DB baselines in the mean scores . In addition , statistically significant improvements over baseline were also seen for some Continuous Performance Task ( which is a test for attention and impulsivity ) parameters . Overall , no deterioration of cognitive function was observed while participants were treated with risperidone . Almost half of the 8.5 kg gained was attributable to normal growth . Asymptomatic peak prolactin levels were observed within 4 weeks of beginning risperidone treatment and declined over time to within normal range . At study endpoint , mean prolactin levels were statistically significantly greater than baseline only in male participants but still < 20 ng/mL , which is within the normal range . Twenty participants experienced mild or moderate extrapyramidal symptoms , although none withdrew for this reason . CONCLUSIONS Risperidone , administered as an oral solution at a mean dose of 1.38 mg/d ( range : 0.02 - 0.06 mg/kg/d ) for 1 year , was well tolerated , safe , and showed maintenance of effect in the treatment of disruptive behavior disorders in children aged 5 to 12 years with subaverage IQs OBJECTIVE The purpose of this study was to conduct a pilot r and omized trial of dialectical behavior therapy ( DBT ) versus psychosocial treatment as usual ( TAU ) for adolescents diagnosed with bipolar disorder ( BP ) . METHODS We recruited participants 12 - 18 years of age with a primary BP diagnosis ( I , II , or operationalized not otherwise specified [ NOS ] criteria ) from a pediatric specialty clinic . Eligible patients were assigned using a 2:1 r and omization structure to either DBT ( n=14 ) or psychosocial TAU ( n=6 ) . All patients received medication management from a study -affiliated psychiatrist . DBT included 36 sessions ( 18 individual , 18 family skills training ) over 1 year . TAU was an eclectic psychotherapy approach consisting of psychoeducational , supportive , and cognitive behavioral techniques . An independent evaluator , blind to treatment condition , assessed outcomes including affective symptoms , suicidal ideation and behavior , nonsuicidal self-injurious behavior , and emotional dysregulation , quarterly over 1 year . RESULTS Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU , possibly reflecting greater engagement and retention ; both treatments were rated as highly acceptable by adolescents and parents . As compared with adolescents receiving TAU , adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up , and were nearly three times more likely to demonstrate improvement in suicidal ideation . Models indicate a large effect size , for more weeks being euthymic , over follow-up among adolescents receiving DBT . Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment , adolescents receiving DBT , but not those receiving TAU , evidence d improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation . CONCLUSIONS DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents with BP . The DBT focus on commitment to treatment may be important for the treatment of early-onset BP . Larger controlled trials are needed to establish the efficacy of this approach , examine impact on suicidal behavior , and demonstrate cost effectiveness OBJECTIVE Many children with pervasive developmental disorders ( PDDs ) have serious , functionally impairing behavioral problems .  We tested whether combined treatment ( COMB ) with risperidone and parent training ( PT ) in behavior management is superior to medication alone ( MED ) in improving severe behavioral problems in children with PDDs . METHOD This 24-week , three-site , r and omized , parallel-groups clinical trial enrolled 124 children , aged 4 through 13 years , with PDDs , accompanied by frequent tantrums , self-injury , and aggression . The children were r and omized 3:2 to COMB ( n = 75 ) or MED ( n = 49 ) . The participants received risperidone monotherapy from 0.5 to 3.5 mg/day ( with switch to aripiprazole if risperidone was ineffective ) . Parents in the COMB group ( n = 75 ; 60.5 % ) received a mean of 10.9 PT sessions . The primary measure of compliance was the Home Situations Question naire ( HSQ ) score . RESULTS Primary : intent-to-treat r and om effects regression showed that COMB was superior to MED on HSQ ( p = .006 ) [ effect size at week 24 ( d ) = 0.34 ] . The HSQ score declined from 4.31 ( ± 1.67 ) to 1.23 ( ± 1.36 ) for COMB compared with 4.16 ( ± 1.47 ) to 1.68 ( ± 1.36 ) for MED . Secondary : groups did not differ on Clinical Global Impressions-Improvement scores at endpoint ; compared with MED , COMB showed significant reductions on Aberrant Behavior Checklist Irritability ( d = 0.48 ; p = .01 ) , Stereotypic Behavior ( d = 0.23 ; p = .04 ) , and Hyperactivity/Noncompliance subscales ( d = 0.55 ; p = .04 ) . Final risperidone mean dose for MED was 2.26 mg/day ( 0.071 mg/kg ) , compared with 1.98 mg/day for COMB ( 0.066 mg/kg ) ( p = .04 ) . CONCLUSIONS Medication plus PT result ed in greater reduction of serious maladaptive behavior than MED in children with PDDs , with a lower risperidone dose Daily anticonvulsant drug therapy is the major treatment of seizure disorders . Compliance with the prescribed therapy is essential but not always achieved . Among 201 pediatric seizure clinic patients taking phenobarbital and phenytoin , 70 ( 35 % ) were judged noncompliant on at least one medication . The mothers of these patients were r and omly assigned to experimental or control groups . An educational intervention in the form of a mothers ' group discussion led by the clinic social worker was tested . On follow-up , medication compliance in the intervention group was judged significantly greater than that of the control group We evaluated the feasibility of DBT  training , adherence , and retention preparing for a r and omized controlled trial of Dialectical Behavior Therapy ( DBT ) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder . Therapists were intensively trained and evaluated for adherence . Adherence scores , treatment retention , and present and previous self-harm were assessed . Twenty-seven patients were included ( mean age 15.7 years ) , all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder . Therapists were adherent and 21 ( 78 % ) patients completed the whole treatment . Three subjects reported self-harm at the end of treatment , and urges to self-harm decreased . At follow up , 7 of 10 subjects reported no self-harm .  DBT was found to be well accepted and feasible . R and omized controlled trials are required to test the effectiveness of DBT for adolescents Non-response to pharmacotherapy for panic disorder ( PD ) is a well-documented problem . However , little information exists to guide next-step strategies for these non-responders . In addition to pharmacologic augmentation strategies , several studies support the efficacy of cognitive-behavior therapy ( CBT ) for these patients , although data on long-term outcomes has been lacking . In this study , we provide one-year outcomes on a sample of 63 patients who completed group CBT for PD after failing to respond adequately to previous pharmacotherapy . Sustained significant benefit was found for all dimensional outcome scores , and nearly two-thirds of the sample met remission criteria . This occurred with reductions in medication use over the follow-up period . Negative predictors of remission status included comorbid dysthymia , social phobia , and generalized anxiety disorder . These results provide additional evidence for the efficacy of CBT for medication non-responders with PD OBJECTIVE The aim of this study was to determine the long-term safety of risperidone as maintenance therapy in children and adolescents with disruptive behavior disorders ( DBDs ) and normal intelligence . METHOD An open-label , 1-year extension study was conducted from January , 2002 , to July , 2004 , in 232 subjects with DBDs ( 5 - 17 years ) previously r and omized to risperidone ( RIS ) ( n = 115 , RIS/RIS ) or placebo ( PLA ) ( n = 117 , PLA/RIS ) in a double-blind , 6-month withdrawal study .  Adverse events ( AEs ) and clinical laboratory test results were recorded . Efficacy was assessed using Nisonger Child Behavior Rating Form . Safety and efficacy were evaluated in the intent-to-treat population . RESULTS A total of 169/232 ( 73 % ) subjects completed the study . Subjects were predominantly male , with a diagnosis of oppositional defiant disorder . Risperidone was generally well tolerated . Weight gain and extrapyramidal symptoms were each reported as AEs by 10 subjects ( 4.3 % ) . Mean weight z-scores decreased for RIS/RIS subjects ( -0.04 + /- 0.28 ) and increased for PLA/RIS subjects ( 0.11 + /- 0.43 ) . No subject developed tardive dyskinesia . Prolactin tended to increase with risperidone , although this effect diminished with prolonged use and was infrequently associated with AEs . There were no clinical ly relevant changes in glucose or lipid metabolism . Clinical improvement in DBD symptoms was observed with flexible risperidone doses , regardless of previous treatment and whether subjects had experienced symptom recurrence . CONCLUSIONS Risperidone reinitiated for DBD in children with normal intelligence quotients ( IQ ) was safe and well tolerated over an additional year of treatment . Patients demonstrated clinical benefits , including those who previously experienced symptom recurrence Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder ( ADHD ) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and , in case of insufficient response to initial treatment , whether increasing dose of initial treatment or adding the other treatment modality is superior . Children with ADHD ( ages 5–12 , N = 146 , 76 % male ) were treated for 1 school year . Children were r and omized to initiate treatment with low doses of either ( a ) behavioral parent training ( 8 group sessions ) and brief teacher consultation to establish a Daily Report Card or ( b ) extended-release methylpheni date ( equivalent to .15 mg/kg/dose bid ) . After 8 weeks or at later monthly intervals as necessary , insufficient responders were rer and omized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality , with adaptive adjustments monthly as needed to these secondary treatments . The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations ( the primary outcome ) at study endpoint and tended to have fewer out-of-class disciplinary events . Further , adding medication secondary to initial behavior modification result ed in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication . Normalization rates on teacher and parent ratings were generally high . Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication . Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication PURPOSE Medication nonadherence is one of the most important reasons for treatment failure in patients with epilepsy . The present study investigated the effectiveness of a multicomponent intervention to improve adherence to antiepileptic drug ( AED ) medication in patients with epilepsy . METHODS In a prospect i ve , r and omized multicenter trial , three sessions of face-to-face motivational interviewing ( MI ) in combination with complementary behavior change techniques were compared with st and ard care . Motivational interviewing prompted change talk and self-motivated statements from the patients , planning their own medication intake regimen and also identifying and overcoming barriers that may prevent adherence . Participants were provided with calendars to self-monitor their medication taking behavior . A family member and the health-care team were invited to attend the last session of MI in order to improve the collaboration and communication between patients , their caregiver or family member , and their health-care provider . At baseline and 6-month follow-up , psychosocial variables and medical adherence were assessed . RESULTS In total , 275 participants were included in the study . Compared with the active control group , patients in the intervention group reported significantly higher medication adherence , as well as stronger intention and perceptions of control for taking medication regularly . The intervention group also reported higher levels of action planning , coping planning , self-monitoring , and lower medication concerns . CONCLUSIONS This study shows that MI can be effective in clinical practice to improve medication adherence in patients with epilepsy . It also provides evidence that combining volitional interventions , including action planning , coping planning , and self-monitoring with motivational interviewing can promote the effectiveness of the medical treatments for epilepsy by improving adherence
Results There is some evidence of the effectiveness of medication in treating DBDs , with positive outcomes for lithium and risperidone in particular .
Pharmacotherapy also demonstrated some efficacy in reducing symptoms of aggression .
Medication was relatively well-tolerated , as indicated by equivalent dropout rates in medication and comparison groups .
Rationale Pharmacotherapy is frequently considered in the treatment of  disruptive behavior disorders ( DBDs ) in children and adolescents .
There are , however , no systematic review s of this literature .
Objectives The aim of this work is to determine whether medication is effective in treating pediatric disruptive behavior disorders and related problems of impulse control , as well as to examine differences in the treatment response and tolerability of different medication classes and agents .