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Kids With ADHD, Aggression May Benefit From 2nd Med

Modest improvements in violent behavior noted with addition of antipsychotic drug
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After nine weeks, children who took Risperdal in addition to their stimulant medication saw modest but significant improvements in behavior compared to those who continued on the stimulant by itself.

"I don't think it's a grand slam, but I do think it indicates that there is some justification for what doctors have begun to do, which is to combine treatment," Aman said.

Aman said the average improvement on Risperdal was moderate. "Buried in that moderate are kids who did much better, kids who did somewhat better and some kids who didn't do better at all," he said.

Aman said scientists really need to look more closely to understand why some children had big improvements with the addition of Risperdal while others got no further help.

In some cases, Risperdal seemed to cancel some of the most bothersome side effects of the stimulants, including loss of appetite and trouble falling asleep.

But Aman cautioned that antipsychotics must always be prescribed with great care since they cause weight gain and increase the risk for type 2 diabetes.

The study was sponsored by a grant from the U.S. National Institute of Mental Health.

About half of children with ADHD who are referred for psychiatric help have behavioral disorders as well as ADHD, according to the U.S. Centers for Disease Control and Prevention.

An expert who was not involved in the research praised the study and said it would help doctors sort out what is often a tricky treatment decision.

In kids with ADHD and aggressive behavior, "recent guidelines say you should try to treat the ADHD first," said Joseph Blader, an associate professor at the University of Texas Health Science Center at San Antonio. "Then the issue is, how long do you spend doing that if the child is having these explosions, these meltdowns, potentially hurting people, on the threshold of getting kicked out of school? Two weeks? Three weeks?"

Blader said that, because so many of the kids in the study's placebo group continued to improve on the stimulant medication alone, doctors might be justified in waiting a few more weeks to see if the aggression improves along with the ADHD.

"I think this study shows that you get a lot of bang for your buck with stimulants and parent training," he said. "Unless it's a very extreme situation, it's optimal to let those play out [before trying a second medication]."

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