Stimulant-Responsive and Stimulant-Refractory Aggressive Behavior Among Children With ADHD
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OBJECTIVES: The objective of this study was to examine factors that are associated with aggression that is responsive versus refractory to individualized optimization of stimulant monotherapy among children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Children who were aged 6 to 13 years and had ADHD, either oppositional defiant disorder or conduct disorder, significant aggressive behavior, and a history of insufficient response to stimulants completed an open stimulant monotherapy optimization protocol. Stimulant titration with weekly assessments of behavior and tolerability identified an optimal regimen for each child. Families also received behavioral therapy. Parents completed the Retrospective-Modified Overt Aggression Scale (R-MOAS) at each visit. Children were classified as having stimulant-refractory aggression on the basis of R-MOAS ratings and clinician judgment. Differences that pertained to treatment, demographic, and psychopathology between groups with stimulant monotherapy–responsive and –refractory aggression were evaluated. RESULTS: Aggression among 32 (49.3%) of 65 children was reduced sufficiently after stimulant dosage adjustment and behavioral therapy to preclude adjunctive medication. Those who responded to stimulant monotherapy were more likely to benefit from the protocol's methylphenidate preparation (once-daily, triphasic release), showed a trend for lower average dosages, and received fewer behavioral therapy sessions than did children with stimulant-refractory aggression. Boys, especially those with higher ratings of baseline aggression and of depressive and manic symptoms, more often exhibited stimulant-refractory aggression. CONCLUSIONS: Among children whose aggressive behavior develops in the context of ADHD and of oppositional defiant disorder or conduct disorder, and who had insufficient response to previous stimulant treatment in routine clinical care, systematic, well-monitored titration of stimulant monotherapy often culminates in reduced aggression that averts the need for additional agents.
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Exacerbation of irritability is a reported side effect of stimulant treatment.
“Clinical decision making in regards to emotional lability is complicated by the fact that exacerbation of irritability is a reported side effect of stimulant treatment [42, 43].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [43]
The Results (Tolerability and Adverse Effects; page unavailable) describe adverse-effect monitoring but do not identify exacerbated irritability as a stimulant side effect. The Results (Child Factors Associated With Aggression Outcome; page unavailable) say no child had worsening mood-relevant symptoms on their optimized stimulant regimen. I searched for irritability, worsening, and adverse effects; the study's finding does not establish or rule out whether irritability has been reported as a side effect elsewhere. (LLM, conf=0.73)
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References 38 · Cited by 106
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- Authors
- Blader, J. C., Pliszka, S. R., Jensen, P. S., Schooler, N. R., & Kafantaris, V.
- Affiliations
- Northwell Health (US)
- The University of Texas at San Antonio Health Science Center (US)
- Mayo Clinic (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2010-10-01
- Volume
- 126
- Issue
- 4
- Pages
- e796-e806
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC2956067
- OpenAlex
- W2127863943
- Cited by
- 106
- References
- 38
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 8 · 2018: 3 · 2017: 10 · 2016: 11 · 2015: 9 · 2014: 7 · 2013: 8 · 2012: 8
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Shire
- National Institute of Mental Health (K23MH064975)
- National Center for Research Resources (#M01RR10710, M01RR010710)
- Janssen Pharmaceuticals
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, aggression, methylphenidate, oppositional defiant disorder, conduct disorder, behavior therapy, depressive symptoms, manic symptoms, sex differences, children
- MeSH terms
- Adolescent, Aggression, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Delayed-Action Preparations, Female, Humans, Male, Methylphenidate, Treatment Failure, Conduct Disorder
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