New Drug May Help Children With Uncontrollable Aggression
"Risperidone may be a very powerful and effective treatment, although larger, definitive studies need to be conducted to confirm or refute our findings," Findling tells WebMD.
Hans Steiner, MD, professor of psychiatry at Stanford University School of Medicine, agrees. "We're just at the beginning in finding out what [medication] can do for conduct problems and aggression in kids. This is a very important study. ... It's the first to report on a new [drug for this population]," says Steiner. He notes that very few well-conducted human trials have been published on the treatment of conduct disorder. Steiner is the author of the American Academy of Child and Adolescent Psychiatry's guidelines concerning the proper assessment and treatment of children and adolescents with conduct disorder.
He suggests that longer-term studies are needed to evaluate whether children and adolescents can tolerate Risperdal for months or years and to see whether its effect wears off with time.
"This is a preliminary study that is certainly noteworthy because risperidone has not been thought of as a first-line medicine for the treatment of CD. What's wonderful about this study is that there may be a medicine that can be helpful," he says. However, he points out that other medications that have been thought to be effective have been proven later not to be.
According to Koplewicz, psychological treatments and social interventions for CD do not seem to be very effective. Many children end up in costly residential treatment centers. Children with CD should be treated with a variety of approaches including family therapy, psychotherapy, and social skills building, as well as medication.
Findling says that he would recommend that Risperdal be used cautiously for conduct disorder in addition to other therapy. "Right now there aren't many proven treatments for this population. ... We continue to use risperidone for [only] these well-described, extremely aggressive young people."
Findling emphasizes that Risperdal is not a treatment for aggression per se, but rather is a potential treatment for this carefully defined population with serious, chronic, impulsive, and aggressive behavior. It is not for those with mood disorders, anxiety disorders, or substance abuse.
Koplewicz says that there are currently about 2 million children in the U.S. under the age of 18 who have CD. "As a nation, this is a disorder that really needs a lot more research and attention -- as evidenced by school shootings and school violence. The cost to society of ... these kids left untreated is astronomical."