Pharmacotherapy for Children and Adolescents with Conduct Problems
Conduct problems can be formally classified as “disruptive behavior disorders” which include conduct disorder (CD), oppositional defiant disorder (ODD), and disruptive behavior disorder not otherwise specified (DBD-NOS) in the Diagnostic and Statistical
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Conduct problems can be formally classified as “disruptive behavior disorders” which include conduct disorder (CD), oppositional defiant dis order (ODD), and disruptive behavior disorder not otherwise specified (DBD-NOS) in the Diagnostic and Statistical Manual 4th edition (DSMIV-TR; American Psychiatric Association, 2000). Conduct Disorder is a serious disorder which is characterized by persistent antisocial behavior and can be helpfully divided into early (before the age of 10 years) or late onset. Clinicians are often pessimistic about the effectiveness of treatment options available to manage CD and ODD; in particular, many are skep tical about the value of pharmacological treatments for managing CD and ODD, but is this skepticism justified? First-line treatments for conduct problems are psychosocial/psy chotherapeutic in nature (Findling, 2008; Pappadopulos et al., 2006) and include Multisystemic Therapy and Collaborative Problem Solving approaches (Greene & Ablon, 2003; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998), among others (see chapters in this book). These first-line interventions are unfortunately not available in all areas, and even where they are accessible, not every child will respond and it may be necessary to consider medication as an alternative.
Helen L. Smith ● University of Dundee david r. coghill ● University of Dundee
R.C. Murrihy et al. (eds.), Clinical Handbook of Assessing and Treating Conduct Problems in Youth, DOI 10.1007/978-1-4419-6297-3_15, © Springer Science+Business Media, LLC 2010
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helen L. Smith and david R. Coghill
In all cases, treatment should follow a detailed assessment, which includes a risk assessment and the clear identification of the aims of and targets for intervention. Most of the medications detailed below have been used with the aim of either (a) generally reducing the core symptoms of con duct problems or (b) specifically targeting and reducing levels of aggression as this is often the most visible symptom of these disorders. One potential benefit of medications over psychosocial interventions is their ability to produce a faster response and therefore result in a quicker reduction in the risk of harm to others (Caldwell, Maltereer, Umstead, & McCormick, 2008). Early intervention is linked to efficacy (Moretti et al., 1997) and the addition of medication can also increase the efficacy of behavior modifica tion programs (Caldwell et al.). When the clinical team has decided on the targets for intervention, they then need to be clear about how they will be measured and how change will be monitored. Various scales are available, but it is important to remember that whichever scale is used, it should be valid and reliable and be able to accurately measure change and response to treatment. Sev eral of the common scales used in research are listed below. General scales measuring the symptoms of conduct problems include the aberrant behaviour checklist (ABC; Aman, Singh, Stewart, & Field, 1985) and the Nisonger Child Behaviour Ra
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