April 4, 2000 (New York) -- After seven weeks of treatment with Risperdal (risperidone), a relatively new drug usually used to treat schizophrenia, both doctors and parents noticed that the aggressive behavior of children with "conduct disorder" (CD) noticeably improved, according to a report in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
CD is an illness diagnosed in childhood or adolescence in which kids show uncontrolled aggression toward animals and people, destroy property, steal, are deceitful, and have no respect for rules. "CD is one of the most difficult psychiatric illnesses to treat," says Harold Koplewicz, MD, director of New York University's Child Study Center. "Kids with CD are more likely to be aggressive toward others, including physical and verbal aggression. One of the most noteworthy characteristics is the lack of remorse for what they do," he tells WebMD.
CD is often a precursor to more extreme pathological behavior that worsens as the child develops. "Quite clearly, if you look at our jails, they're filled with adults who demonstrated CD symptoms at an early age," says Koplewicz.
Older medications may reduce aggressive behavior in youngsters with CD, but they are often limited by such side effects as sedation, drooling, or abnormal movements. Since these reactions may not be acceptable to either the child or the child's parent, alternative treatments for conduct disorders are needed. With this in mind, investigators decided to see if Risperdal, which is relatively free of side effects, could be used to treat CD.
Twenty children and adolescents -- 19 boys and one girl, aged 6 to 14 -- who had been diagnosed with conduct disorder were enrolled in the study. Half the youngsters were treated daily with Risperdal daily for 10 weeks.
The investigators found that Risperdal was superior to a placebo in reducing aggression. The Risperdal patients' parents also reported improvements in conduct problems and delinquency behavior.
Risperdal also did not cause too many bad side effects, but Risperdal-treated participants gained more weight than those in the placebo group, which may be an obstacle to long-term therapy in this population, says author Robert L. Findling, MD, director of child and adolescent psychiatry at University Hospitals in Cleveland.
"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."
- Conduct disorder is diagnosed in children and adolescents and is characterized by aggression toward animals and people, destruction of property, theft, deceitfulness, a lack of respect for rules, and a lack of remorse.
- Typically this condition is difficult to treat, but a new drug called Risperdal was shown to be effective, at least in the short term.
- In addition to medication, children with conduct disorder may require a variety of other interventions, such as family therapy, psychotherapy, and social skills building.