Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management

To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an e...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2012-06, Vol.129 (6), p.e1577-e1586
Main Authors: Scotto Rosato, Nancy, Correll, Christoph U, Pappadopulos, Elizabeth, Chait, Alanna, Crystal, Stephen, Jensen, Peter S
Format: Article
Language:English
Subjects:
Adolescent
Adolescent aggressiveness
Aggression - drug effects
Aggression - psychology
Aggressiveness
Aggressiveness (Psychology) in adolescence
Care and treatment
Children & youth
Consensus Development Conferences as Topic
Disease Management
Dosage and administration
Drug therapy
Evidence-Based Medicine - standards
Humans
Medical case management
Mental Disorders - diagnosis
Mental Disorders - drug therapy
Mental Disorders - psychology
Mental health
Methods
Pediatrics
Practice guidelines (Medicine)
Practice Guidelines as Topic - standards
Primary care
Psychotherapy
Psychotherapy - methods
Psychotherapy - standards
Psychotropic drugs
Psychotropic Drugs - pharmacology
Psychotropic Drugs - therapeutic use
Social Support
Treatment Outcome
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Summary:To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an expert survey of recommended practices; a consensus conference of researchers, policymakers, clinicians, and family advocates; and review by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth guidelines reflect a synthesis of the available evidence, based on this multistep process. This article describes the content, rationale, and evidence for 11 recommendations. Key treatment principles include considering psychosocial interventions, such as evidence-based parent and child skills training as the first line of treatment; targeting the underlying disorder first following evidence-based guidelines; considering individual psychosocial and medical factors, including cardiovascular risk in the selection of agents if medication treatment (ideally with the best evidence base) is initiated; avoiding the use of multiple psychotropic medications simultaneously; and careful monitoring of treatment response, by using structured rating scales, as well as close medical monitoring for side effects, including metabolic changes. Treatment of children with maladaptive aggression is a "moving target" requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2010-1361