Treatment of Aggression in Children

Many young people display aggressivebehavior, for a variety of reasons. In the majority of cases, aggressive behavior is not pathologic and can be treated with nonpharmacologic interventions. A careful diagnostic assessment is crucial to identifying causes and potential treatments of aggression in children. Psychiatric conditions associated with aggression that can be identified in childhood include conduct disorder, oppositional defiant disorder, disruptive behavior disorder not otherwise specified, and attention-deficit/hyperactivity disorder. The majority of young patients with aggressive behavior are not appropriate candidates for pharmacotherapy. However, for a small number of young people with persistent, pernicious, pervasive aggression over a longitudinal course, pharmacotherapy may be a rational treatment approach. When chronic aggression goes untreated, repercussions are costly and likelihood of a poor outcome is high. Safe, effective interventions are needed. Studies reviewed in this article show the efficacy of the stimulant methylphenidate, the mood stabilizer lithium, typical antipsychotics, and the atypical antipsychotic risperidone in treating aggressive behavior in children and adolescents. Although there is a growing body of data about the treatment of youths with a primary diagnosis of conduct disorder and its related conditions, more research is needed into pharmacotherapeutic treatments for the small number of young people who are impaired by uncontrollable aggression within the context of these disorders.