Risperidone Added to Parent Training and Stimulant Medication: Effects on Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Peer Aggression

Abstract

Objective In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication and placebo (Basic) versus parent training, stimulant, and risperidone (Augmented) therapy by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced—impairment, and informant discrepancy. Method Children (6-12 years; N=168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks. Results Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p=.02, Cohen's d=0.27) and peer aggression (p=.02, Cohen's d=0.32), but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at Week 9/endpoint (p=.008). Teacher ratings indicated greater reduction in ADHD severity (p=.02, Cohen's d =0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated impaired for at least one targeted disorder at Week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%). Conclusion Augmented was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context-specific, and effect sizes ranged from small to moderate.

Comorbid Symptomatology Moderates Response to Risperidone, Stimulant, and Parent Training in Children with Severe Aggression, Disruptive Behavior Disorder, and Attention-Deficit/Hyperactivity Disorder

“…Clinicians selected one rating on a 0 (no event) to 5 (severe events) point scale, based on parent and child report. A score of at least 3 on at least one item was required for study entry (see Gadow et al 2014).…”

Risperidone Added to Psychostimulant in Children with Severe Aggression and Attention-Deficit/Hyperactivity Disorder: Lack of Effect on Attention and Short-Term Memory

“…In addition to the parent report outcome measures described elsewhere Gadow et al 2014), we administered task-oriented measures of cognitive performance at Baseline, week 3, and week 9 (endpoint).…”

Clinical Implications From the Treatment of Severe Childhood Aggression (TOSCA) Study: A Re-Analysis and Integration of Findings

“…Finally, we couple the results of these re-analyses with a review of the results of the initial, 6 extension, 8 and follow-up 9 studies and three secondary reports 7,15,16 to derive practical implications for further study for clinicians who must follow patients over extended periods. This also provides a quick summary of major outcomes of the TOSCA study program.…”

“…In a secondary analysis, augmented treatment also improved teacher-rated ADHD symptoms more than placebo. 7 …”