• Subscribe
  • Register for free Content
  • Cart
  • Login
  • Browse by Topic
    • 13 Reasons Why
    • ABA
    • Abstinence
    • Acamprosate
    • Addiction
    • Addiction Treatment
    • Addyi
    • Adhansia
    • Adhansia XR
    • ADHD
    • ADHD Attention Deficit Hyperactivity Disorder
    • ADHD Rating Scale-5
    • ADHD-RS-5
    • Adherence
    • Adjunct treatment
    • adolescents
    • Aducanumab
    • Aduhelm
    • Adult ADHD
    • Adverse Childhood Experiences (ACES)
    • adverse events
    • affective disorders
    • Affordable Care Act (ACA)
    • aggression
    • Agitation
    • Aid to capacity evaluation (ACE)
    • AIMS test (Assessment of Involuntary Movement)
    • air pollution
    • Akathisia
    • Alcohol
    • alcohol abuse
    • alcohol dependence
    • Alcohol Poisoning
    • Alcohol related liver disease
    • Alcohol Use
    • Alcohol use disorder
    • Alcoholism
    • Alpha Agonists
    • Alternative treatments
    • Alzheimers
    • Amantadine
    • amino acids
    • amphetamine
    • Amphetamines
    • anabolic steroids
    • Andro
    • Androstenedione
    • Anorexia
    • Anorexia Nervosa
    • Anti-NMDA Receptor Encephalitis
    • Antibiotic
    • Anticholinergic burden scale
    • Anticholinergics
    • Antidepressant
    • Antidepressant Augmentation
    • Antidepressants
    • Antipsychotic
    • Antipsychotics
    • Anxiety
    • Anxiety Disorder
    • anxiety disorders
    • APA CE Post-Test
    • Applied Behavioral Analysis
    • Aptensio
    • Aripiprazole
    • ArModafinil
    • Asenapine
    • Assault
    • Assent
    • Assessment
    • asthma
    • atamoxetine
    • Athletic performance
    • Ativan Challenge Test
    • Atomoxetine
    • Atomoxetine (ATX)
    • Atropine
    • attention
    • Attention Deficit Hyperactivity Disorder
    • Atypical Antipsychotics
    • Austedo
    • Autism
    • Autism Spectrum Disorder
    • Autism Spectrum Disorder
    • Autism Spectrum Disorder autism spectrum disorder
    • Behavior therapy
    • Behavioral addiction
    • Behavioral therapy
    • Behavioral treatment
    • Belsomra
    • Benzodiazepine
    • Benzodiazepines
    • Benzphetamine
    • Beta-blockers
    • Billing
    • Bipolar Depression
    • Bipolar Disorder
    • Bipolar II
    • Black youth
    • Bleeding
    • Board Certification
    • Borderline Personality Disorder
    • Boredom
    • BPD
    • BPSD (behavioral and psychological symptoms of dementia)
    • Brain Devices
    • Breastfeeding
    • Brexpiprazole
    • Brief psychotherapy
    • brief pulse
    • Brief Strategic Family Therapy (BFST)
    • Bulimia Nervosa
    • Bullying
    • Bumetanide
    • Buprenorphine
    • Buprenorphine Induction
    • Bupropion
    • Bush-Francis Scale
    • Buspirone
    • C-Reactive Protein
    • Caffeine
    • CAM Treatments
    • Cancer
    • Cannabidiol
    • Cannabis
    • Capacity
    • Caplyta
    • Carbamazepine
    • Cardiovascular
    • Cariprazine
    • Catatonia
    • CATIE
    • CBT
    • CBTi
    • Central Alpha Agonists
    • CGI
    • Chantix
    • Child and adolescent
    • Child Psychiatry
    • Child Psychiatry
    • childcare
    • children
    • children and adolescents
    • Chlorpromazine
    • Chokroverty
    • Chromosomal Microarray
    • circadian system
    • Citalopram
    • Clinical Global Impressions
    • Clinical practice
    • Clinical Practice Guidelines
    • Clozapine
    • CME Post-Test
    • co-morbidities
    • Co-occurring disorders
    • Cocaine
    • Cognition
    • Cognitive Behavioral Therapy
    • Cognitive Behavioral Therapy for Insomnia
    • Cognitive Behavioral Therapy for Insomnia (CBTi)
    • Cognitive Decline
    • Cognitive functioning
    • cognitive impact
    • Cognitive impairment
    • Cognitive Rehabilitation Therapy (CRT)
    • Collaboration
    • Collaborative care
    • Collateral data
    • Combination treatment
    • Combined Pharmacotherapy
    • Commitment
    • community trauma
    • Comorbidity
    • complementary medicine
    • Complementary treatments
    • Complimentary Medicine
    • Complimentary treatments
    • compulsions
    • Computer addiction
    • Computers in Psychiatric Practice
    • Conduct Disorder
    • Confidentiality
    • Connect
    • Connection
    • Connections
    • Consensual
    • Consent
    • Contagion
    • Contempla
    • contingency management
    • contraceptive services
    • control group
    • Coronavirus
    • Cosmetic pharmacology
    • Countertransference
    • court hearings
    • COVID-19
    • COVID19
    • craving
    • creatine
    • creatine monohydrate
    • Creativity
    • Crime
    • Criminal behavior
    • Crisis intervention
    • Crocus Sativus
    • CRP
    • Cultural Competence
    • Culture
    • custody agreement
    • Cymbalta
    • CYP2C19
    • CYP2D6
    • DASH diet
    • Dayvigo
    • De-escalation
    • Debriefing
    • Decisional Capacity
    • Degarelix
    • Deliberate foreign body ingestion
    • Delirium
    • Delusional Disorder
    • Dementia
    • Deplin
    • Deprescribing
    • Depression
    • Depressive Disorder
    • designer drugs
    • Detoxification
    • Deutetrabenazine
    • Developmental Relationship Based Intervention
    • DFBI
    • Diabetes
    • diabetes insipidus
    • Diagnosis
    • Diagnostic Testing
    • diet
    • Dietary Approaches to Stop Hypertension (DASH)
    • Diethylpropion
    • Diphenhydramine
    • Disaster
    • Discrepancies
    • Disparities
    • Dispositional capacity
    • Disruptive Mood Dysregulation Disorder (DMDD)
    • Disulfiram
    • Divalproex
    • Diversity
    • Divorce
    • DMDD
    • Dopamine
    • Dosage Timing
    • Dose Response
    • Dosing
    • double blind
    • DRBI
    • Drooling
    • Droperidol
    • drug misuse
    • Drug-assisted psychotherapy
    • DSM
    • Dual diagnosis
    • Duloxetine
    • duty to protect
    • duty to warn
    • Dyanaval
    • Dyslexia
    • Dysregulation
    • E-Cigarettes
    • Eating Disorders
    • eating restriction
    • eCigarettes
    • ECT
    • effect size
    • Effexor
    • efficacy
    • EHR
    • Electroconvulsive therapy
    • Electronic Health Records
    • electronic use
    • Emergency
    • Emergency Department
    • emergent suicidality
    • emotion dysregulation
    • Emotional dysregulation
    • Encephalitis
    • End of Life Care
    • Engagement
    • Equine Assisted Psychotherapy
    • Equine therapy
    • Escitalopram
    • Esketamine
    • Estrogen
    • Eszopiclone
    • eTNS
    • Evekeo
    • excessive exercise
    • Exercise
    • Existing marijuana
    • expressed emotion
    • extended dosing
    • extended-release
    • Falls
    • Family Separation
    • Fast-acting
    • FDA
    • FDA Warnings
    • Female hypoactive sexual desire disorder
    • Female Issues in Psychiatry
    • fentanyl
    • fetal effects
    • First Generation Antipsychotics (FGAs)
    • fluid restriction
    • Fluoxetine
    • Folate
    • Folic Acid
    • Fragile X
    • Free Articles
    • gabapentin
    • GAD
    • GAMC
    • Gastroenterology
    • GDD
    • Gender
    • Gender & Sexuality
    • Gender Affirming Medical Care
    • Gender Diverse
    • Gender Dysphoria
    • Gender Dysphoric Disorder
    • Gender Identity
    • Generalized Anxiety Disorder
    • Generics
    • GeneSight
    • Genetic Testing
    • Genetics and Psychiatry
    • Geriatric
    • Geriatric Psychiatry
    • Geriatrics
    • Ginkgo
    • Good Psychiatric Management
    • Guanfacine
    • Hair loss
    • Haloperidol
    • Harm reduction
    • Head Trauma
    • Health Apps
    • Healthy aging
    • Hearing loss
    • Heart health
    • Heart rate
    • Hemorrhagic
    • Hepatitis
    • Heroin
    • Higher-calorie refeeding
    • HIPAA
    • Histamine
    • HIV
    • Hormone Replacement Therapy
    • Hospital policy
    • HRT
    • huffing
    • hydroxymethyl butyrate (HMB)
    • Hydroxyzine
    • hypersalivation
    • hypersexual behaviors
    • Hypnotics
    • Hypomania
    • Hyponatremia
    • IDEA
    • Incarceration
    • Inclusion
    • Inclusion strategies
    • Independent Educational Plan (IEP)
    • induction
    • infant
    • Inflammation
    • Ingrezza
    • Inhalants
    • Innovations
    • Inpatient Psychiatry
    • inquiry
    • Insomnia
    • Insulin resistance
    • Insurance
    • intermittent fasting
    • Internet
    • interpersonal stressors
    • Interpreter
    • Intervention
    • Intra-cerebral hemorrhage
    • Intra-nasal
    • involuntary civil commitment
    • Irritability
    • IV immunoglobulin therapy (IVIG)
    • Jornay PM
    • Keppra
    • Ketamine
    • l-methylfolate
    • Laboratory Testing in Psychiatry
    • lactation
    • Lamictal
    • Lamotrigine
    • Language
    • Lavender
    • Learning & Developmental Disabilities
    • Least Restrictive Environment
    • Legal issues
    • Lemborexant
    • Levetiracetam
    • Lewy Body Dementia
    • LGBT
    • LGBTQ+
    • Life coaching
    • Life expectancy
    • Light and Dark Therapy
    • Light therapy
    • Lightbox
    • Liraglutide
    • Literacy
    • Lithium
    • Longevity
    • lorazepam taper
    • Low calorie refeeding
    • Low libido
    • low sodium
    • Lumateperone
    • Lurasidone
    • Lyrica
    • maintenance ECT
    • Malingering
    • Malnourishment
    • Management
    • Mania
    • Mania on Antidepressants
    • MAOIs
    • Marijuana
    • MDMA
    • Media
    • Medical Comorbidities
    • Medical incapacity hold
    • Medication
    • Medication adherence
    • medication capacity hold
    • Medication for Opioid Use Disorder
    • Medication for Opioid Use Disorder (MOUD)
    • medication of opioid use disorder (MOUD)
    • medications
    • Melatonin
    • Memantine
    • memory loss
    • Mental Health
    • Meta-analysis
    • Metabolic syndrome
    • Metformin
    • Methadone
    • Methamphetamines
    • methylfolate
    • methylphenidate
    • Micronutrients
    • Mind-Gut Connection
    • Mindfulness
    • Minocycline
    • Minority
    • Mirtazapine
    • Mixed Features
    • Modafinil
    • Mood
    • mood disorders
    • Mood stabilizer
    • Mood Stabilizers
    • Mortality
    • Motivational Interviewing
    • MTA
    • MTHFR
    • muscle dysmorphia
    • Mydayis
    • Naloxone
    • Naltrexone
    • Narcolepsy
    • Natural Medications
    • natural treatments
    • Naturalistic Developmental-Behavioral Intervention
    • NDBI
    • Negative Symptoms
    • Negative symptoms of schizophrenia
    • Netflix
    • neuroleptic malignant syndrome
    • Neurology
    • Neuroscience in Psychiatry
    • Neurotoxicity
    • New York
    • newborn
    • News of Note
    • nicotine
    • Nightmares
    • NMDA
    • NNH
    • NNT
    • Nomogram
    • Non-pharmacologic
    • Non-suicidal self-injury
    • Norepinephrine
    • Nortriptyline
    • Novel drug
    • Novel Medications
    • Nuedexta
    • null hypothesis
    • number needed to harm
    • number needed to treat
    • Nuplazid
    • Nurses
    • Nutrition
    • Nuvigil
    • Obesity
    • observational study
    • obsessions
    • Obsessive Compulsive Disorder
    • Obsessive compulsive disorder/OCD
    • OCD
    • olanzapine
    • Omega-3
    • Online Learning
    • online therapy
    • Open Label
    • Opioid antagonist
    • Opioid epidemic
    • Opioid Use Disorder
    • Opioids
    • oppositional behavior
    • Oral Contraceptives
    • Orexin
    • Orthostasis
    • Osmolality
    • Osteporosis
    • Outcome tracking
    • Outcomes
    • Outpatient
    • Over the counter
    • Over the counter medication
    • Overdiagnosis
    • Overdose
    • Oxcarbazepine
    • p-value
    • Pain
    • pandemic
    • Panic Disorder
    • Parent Training
    • Parenting Strategies
    • Parents
    • Parkinson’s
    • Parkinson’s Disease
    • Paroxetine
    • Particulate matter
    • Patch
    • Patient relationship
    • pediatric
    • Pediatric Acute Onset Neuropsychiatric Syndrome (PANS)
    • Pediatric Autoimmune Neurologic Disorder Associated with Streptococcus (PANDAS)
    • Pedophilic Disorder
    • Performance Enhancing Substances
    • Perseveration
    • Perseverative Behavior
    • Personality Disorders
    • Pharmaceutical Industry
    • Pharmacogenomics
    • Pharmacology
    • Pharmacology Tips
    • Pharmacotherapy
    • Pharmacy
    • Phendimetrazine
    • Phentermine
    • phonemic awareness
    • Phonics
    • Physician assisted suicide
    • Pica
    • PICOT
    • Pimozide
    • Pitolisant
    • Podcast
    • polypharmacy
    • post traumatic stress disorder
    • post-exposure prophylaxis
    • Post-hoc Analysis ADHD Rating Scale-5
    • Post-menopausal
    • Post-stroke depression
    • Posterior Probability
    • Postpartum Depression
    • Potency
    • Practice management
    • Practice Tools and Tips
    • Practice Tools and Tips
    • Pramipexole
    • Prazosin
    • Pregabalin
    • Pregnancy
    • pregnancy testing
    • Prepubescent children
    • prescribing patterns
    • Prescription costs
    • prevalence
    • Prevention
    • Primary care
    • primary outcome
    • Prison
    • Privacy
    • Prodrome
    • Prolactin
    • Prolonged exposure
    • Promethazine
    • Promotoras
    • Pronouns
    • Provigil
    • Prozac
    • pseudobulbar affect
    • Psilocybin
    • Psychedelics
    • Psychiatric interviewing
    • Psychoanalysis
    • Psychodynamic therapy
    • Psychological First Aide
    • Psychopharm Myths
    • Psychopharmacology
    • Psychopharmacology Tips
    • Psychosis
    • Psychotherapy
    • Psychotherapy
    • Psychotic Agitation
    • Psychotic Depression
    • psychotic disorders
    • Psychotropic medication
    • PTSD
    • Public health
    • Qelbree
    • Quality of care
    • quality of life
    • Quetiapine
    • Quillivant
    • Race
    • Raloxifene
    • Randomized controlled trial
    • randomized discontinuation design
    • rapid naming
    • Rapid-acting
    • RCT
    • Reading
    • Reading disorder
    • Reading Disorders
    • Reading remediation
    • recovery time
    • Red Cross
    • Refeeding syndrome
    • Registered Articles
    • Relationships
    • Remediation
    • Repetitive Behavior
    • Repetitive behaviors
    • replication
    • reporting requirements
    • Research
    • Research Update
    • Research Updates
    • Respectful Care
    • restrictive dieting
    • retarded vs excited catatonia
    • retention
    • Retirement
    • retrograde amnesia
    • Riluzole
    • Risk
    • Risk Management
    • Risk of Addiction
    • Risperidione
    • Risperidone
    • Ritalin
    • rTMS
    • safety
    • Safety Planning
    • Saffron
    • SAMe
    • Samidorphan
    • Saphris
    • Schizoaffective disorder
    • Schizophrenia
    • School Phobia
    • School Refusal
    • ScreeninGeg
    • Seasonal Affective Disorder
    • Second Generation Antipsychotics (SGAs)
    • secondary outcome
    • Secuado
    • Self-injury
    • Self-Regulation
    • Semaglutide
    • Separation
    • Separation Anxiety
    • SERM (Selective Estrogen Receptor Modulator)
    • Serotonin
    • Serotonin Norepinephine Reuptake Inhibitors
    • Serotonin Specific Reuptake Inhibitors
    • Serotonin Specific Reuptake Inhibitors (SSRIs)
    • Sertraline
    • Sex offenders
    • Sex Therapy
    • Sexual Abuse
    • Sexual Dysfunction
    • sexual intercourse
    • Sexual Side Effects
    • SIADH
    • Side Effects
    • Silexan
    • Skype
    • Sleep
    • Sleep Apnea
    • Sleep Disorders
    • Sleep Onset Insomnia
    • Smoking Cessation
    • Smoking Cessation Agents
    • smoking cessations
    • SNRIs
    • Social Anxiety
    • Social Anxiety Disorder
    • social cohesion
    • sodium supplementation
    • Somnambulism
    • Special populations
    • Specific Phobia
    • SSRIs
    • statistical significance
    • Statutes
    • Stereotypical Behavior
    • steroids
    • STI screening
    • Stigma
    • stimulant
    • Stimulant Medications
    • Stimulant treatment
    • Stimulant use disorder
    • Stimulants
    • Stroke
    • structured literacy
    • Suboxone
    • Substance Abuse
    • Substance Abuse
    • Substance Use
    • Substance Use Disorder
    • Substance use disorders
    • Suicidality
    • Suicide
    • Sundowning
    • Supplements
    • Surrogate decision-maker
    • Suvorexant
    • Swallowing
    • Symptom Assessment
    • Symptom Management
    • Systematic review
    • Tags
    • Tantrums
    • Tarasoff
    • Tardive dyskinesia
    • Technology
    • Teen
    • teens
    • Telehealth
    • Telemed
    • Telemedicine
    • Telepsychiatry
    • test cme quiz
    • testifying
    • Tetrabenazine
    • TFCBT
    • TGD
    • Therapy during medication appointment
    • Therapy with Med Management
    • tics
    • TMS
    • Tobacco
    • tobacco research
    • Tobacco use disorder
    • Top 10 Podcasts of 2021
    • Topiramate
    • Toxic Stress
    • Transcranial Magnetic Stimulation
    • Transdermal
    • Transgender
    • Translator
    • Trauma
    • Trauma Informed Care
    • Traumatic Brain Injury (TBI)
    • Trazodone
    • treatment
    • treatment efficacy
    • treatment pediatric
    • Treatment planning
    • Treatment-Resistant Depression
    • Trigeminal Nerve Stimulation
    • Trintellix
    • unblinded
    • Understanding Psychiatric Research
    • unilateral vs bilateral
    • urinary difficulties
    • Valbenazine
    • Valproate
    • Vaping
    • Varenicline
    • Venlafaxine
    • verbal de-escalation
    • videogaming addiction
    • Viloxazine
    • Violence
    • Vitamin B6
    • Vitamin D
    • Vitamin E
    • VMAT2 Inhibitors
    • Vortioxetine
    • Vyleesi
    • Waist circumference
    • Wakix
    • water intoxication
    • water restriction
    • Weed
    • Weight gain
    • Weight Loss Medications
    • Weiss Functional Impairment Rating Scale-Parent (WFIRS-P)
    • Wellbutrin
    • whey protein powders
    • Whole Genome Sequencing
    • Wilderness Therapy Programs
    • Withdrawal
    • Women's Issues in Psychiatry
    • Women’s Issues in Psychiatry
    • Working With Families
    • workplace
    • Xenazine
    • Youth
    • Zenzedi and ProCentra
    • Ziprasidone
  • HOME
  • STORE
  • CME CENTER
  • Blog
  • Podcast
  • NEWSLETTERS
    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
  • Archive
  • Archive
  • Archive
  • Archive
  • Archive
  • The Carlat Child Psychiatry Report
  • Overarousal in Children and Adolescents (Oct/Nov/Dec)
  • Unpacking Aggression Associated with ADHD

Unpacking Aggression Associated with ADHD

The Carlat Child Psychiatry Report, Volume 12, Number 7&8, October 2021
https://www.thecarlatreport.com/newsletter-issue/ccprv12n78/

From The Carlat Child Psychiatry Report, October 2021, Overarousal in Children and Adolescents

Issue Links: Learning Objectives | Editorial Information | PDF of Issue

Topics: ADHD | aggression | Risperidone | Stimulants | Valproate

Print Friendly, PDF & Email

Joseph C. Blader, PhDJohn C. Blader, PhD

Child and adolescent psychologist at the University of Texas Health Science Center, San Antonio, TX.

Dr. Blader has disclosed that he has received funding from Supernus Pharmaceuticals for one research grant unrelated to this topic and these medications. Dr. Feder has reviewed this article and found no evidence of bias in this educational activity.

CCPR: You recently did a study on stepped treatment for ADHD and aggressive behavior (Blader JC et al, J Am Acad Child Adolesc Psychiatry 2021;60(2):236–251). It is riveting in its relevance to everyday practice. I am thinking of one school-age child who came to me after multiple trials of stimulants and mood stabilizers who was still very impulsively aggressive, where we were considering out-of-home placement. Can you give us an overview of what you did?
Dr. Blader: We enrolled 175 children ages 6–12 years with diagnosis of ADHD complicated by aggressive behavior. They were all treated with stimulants, and of the 151 children who completed the stimulant trial, 96 responded in terms of showing less aggression. The remaining 45 children whose aggressive behavior did not respond to stimulants were randomized to adjunctive risperidone, valproate, or placebo.

CCPR: What was the outcome?
Dr. Blader: While we did find some benefit from the adjunctive medications, the numbers were too small to see a clear difference between risperidone and valproate, if there is one. The message of the study became less about the adjunctive medication and more about the importance of using a structured approach to stimulant treatment for ADHD with aggression. The surprising result was that stimulants alone were so helpful in reducing aggression.

CCPR: Your study reverses our usual expectations. This is extremely helpful in conceptualizing how to improve community care. Tell us what motivated your study.
Dr. Blader: We felt that we needed to find better ways to treat kids with ADHD and low frustration tolerance who get upset at the drop of a hat. We used to call this “masked depression” that got put out in the world as anger. Then we started calling it bipolar disorder or some variant thereof. Now these children are often labeled with the term “emotional dysregulation” and we use DSM-5’s disruptive mood dysregulation disorder (DMDD). This is not a new condition, it’s just being thought of in different ways. Successful treatment of aggressive kids with ADHD is largely about more avid and precise pursuit of first-line treatment.

CCPR: What specific symptoms are you focused on when we talk about aggression in ADHD?
Dr. Blader: The underlying ingredients have always been problems with impulse control, with something else affective going on. And it’s that affective piece that has influenced trends in combination medication treatment or the more pejorative polypharmacy, without much data to support it.

CCPR: What medications have typically been used?
Dr. Blader: Antipsychotics have been used in children with severe behavioral disorders for a long time. That was more in desperation, capitalizing on the major tranquilizer aspects. But as we began to think more about the underlying affective component, we began to turn to lithium and other mood stabilizers. Second-generation antipsychotics were thought to be more benign with respect to extrapyramidal symptoms (EPS). While for many patients those products have been a godsend, the approach has led to excessive use of antipsychotics in young people.

CCPR: But were there studies to support this approach of layering on additional medication?
Dr. Blader: No. This proliferation of polytherapies hadn’t been examined the way we would need to see to validate whether it’s an effective strategy. Numerous trials of different patient populations treated with risperidone vs placebo found that risperidone was better than nothing (Olfson M et al, JAMA Psychiatry 2015;72(9):867–874). But in the study we published, we presented data supporting the argument for treating the ADHD first.

CCPR: Talk to us about some of those reasons for focusing first on the ADHD.
Dr. Blader: First, stimulants are safe and effective, with a large effect size. Second, if you’re lucky, the medicine itself may impact irritability and emotional overreactivity and/or improve impulse control and attention enough. Now your environmental changes and behavioral strategies have a better shot at being successful. And third, if you have some success with antipsychotic monotherapy to curb the outbursts and the volatility, you still have to treat the ADHD. Antipsychotics are not the magic bullet for improved attention, academic issues, and related problems. Sooner or later, you need to treat the ADHD.

CCPR: It’s hard to know what to target first.
Dr. Blader: There’s always been a back-and-forth in our field about that. For psychiatrists with adult training who are treating adolescents, they generally tend to see the patient’s aggression and irritability as possible indicators of bipolar disorder type I, and they don’t traditionally give stimulants to a patient with bipolar disorder type I as their opening salvo. Depending on where you trained, there may be a bias toward early initiation of second-generation antipsychotics and mood stabilizers.

CCPR: Given how successful stimulant treatment was for aggression in your study, can you describe the protocol you used for deciding which stimulants to use and how you dosed them?
Dr. Blader: Our stimulant algorithm was structured to titrate methylphenidate up to 72 mg by 18 mg increments at weekly visits until patients scored within one standard deviation of the mean on a Conners Global Index—Parent Form (ConnGI-P) for the child’s age and sex. If methylphenidate didn’t hit the nail on the head, we tried an amphetamine-based product up to 35 mg.

CCPR: What’s the lesson here?
Dr. Blader: Kids in routine care probably would have had an antipsychotic, maybe an antidepressant, and maybe an alpha-agonist for good measure. We can avert that kind of polypharmacy outcome with a methodical approach to first-line treatment.

CCPR: Do you recommend that clinicians routinely use the Conners for tracking symptoms?
Dr. Blader: Yes. For clinical care, we like the Conners, which includes measurement of emotional ability and norms for that subscale (www.tinyurl.com/ckj22u7t). We put a premium on using something short for when you’re doing frequent visits—it’s a pain to do a whole Vanderbilt every single time. You might do a baseline battery, which can include a broad-spectrum measure such as the Child Behavior Checklist (www.tinyurl.com/bwz7ebvn).

CCPR: Thank you for your time, Dr. Blader.

Editor’s note: Our editorial board notes that the use of stimulants can sometimes exacerbate agitation and aggression in our ­patients with autism spectrum disorders (ASD). We want to emphasize that this article pertains to ADHD and aggression in the ­absence of ASD.

Suggested Articles

  • Assessing Feedback From Multiple Sources January 31, 2022 We talk about the importance of gathering data from multiple sources as part of a…
  • Assessing Bipolar Disorder in Children and Adolescents October 18, 2021 Most of us need more clarity to better differentiate bipolar disorder from other problems such…

Powered by Contextual Related Posts

Share this page!
Subscribe
Register for free content

Register For Free Articles

Register to receive free email newsletters with concise, practical advice for busy clinicians. You will also have access to select article content on the website and you will receive notifications of new books and special discount offers.




Courses and Book CME
Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)
2022 Carlat Psychiatry Report Self-Assessment Course
Prescribing Psychotropics: From Drug Interactions to Genetics
The Child Medication Fact Book for Psychiatric Practice (2018)
Issues Archives

2022

  • ADHD in Children and Adolescents (April/May/June)
  • Assessment in Children and Adolescents (January/February/March)

2021

  • Overarousal in Children and Adolescents (Oct/Nov/Dec)
  • Substance Use in Children and Adolescents (Jul/Aug/Sep)
  • Autism in Children and Adolescents (April/May/June)
  • Clinical Complexity With Children and Adolescents (Jan/Feb/Mar)

2020

  • Esketamine (January)
  • Telepsychiatry (May)
  • Mind-Gut Connection (January)
  • Practical Psychotherapy (November/December)
  • Mood and Menopause (October)
  • When to Use Lithium (September)
  • Traumatic Brain Injury (August)
  • Borderline Personality Disorder (June/July)
  • Psychopharmacology Algorithms (April)
  • Bipolar II (March)
  • Inflammation and Depression (February)

2020

  • Mood Disorders in Children and Adolescents (Oct/Nov/Dec)
  • Identity & Culture in Children and Adolescents (July/August/September)
  • Psychosis in Children and Adolescents (April/May/June)
  • ADHD in Children and Adolescents (Jan/Feb/Mar)

2020

  • Harm Reduction (January/February)
  • Substance Use in Health Professionals (March/April)
  • Alternative Treatment in Addiction (November/December)
  • Social Aspects of Addiction (September/October)
  • Opioid Use Disorder Treatment (July/August)
  • Emerging Risks for Old Medications (May/June)

2019

  • Depression (May)
  • Adult ADHD (November/December)
  • Mental Health Apps (October)
  • How to Talk about Medication (September)
  • Side Effects Part II (August)
  • Side Effects Part I (June/July)
  • Sleep (April)
  • Parenting, Pregnancy, and Prevention (March)
  • Dark and Light Therapy (February)
  • Deprescribing (January)

2018

  • Drug Metabolism (November/December)
  • Working With Transgender Patients (October)
  • Emergency Psychiatry (September)
  • Treatment-Resistant Depression (July/August)
  • Neurobiology (June)
  • Anxiety (May)
  • Neurofeedback (April)
  • Antipsychotics Update (March)
  • Working With Families (February)
  • Bipolar Disorder (January)

2017

  • PTSD (December)
  • Retirement (November)
  • Intellectual Disability (September/October)
  • Antidepressants (July/August)
  • Personality Disorders (June)
  • Dementia (May)
  • Cognitive Behavior Therapy Techniques (April)
  • Pharmacogenetics (March)
  • Treating Psychosis (February)
  • Adult ADHD (January)

2016

  • Complementary and Alternative Medicine in Psychiatry (November/December)
  • Side Effects (October)
  • Pain Management (September)
  • Medication in Pregnancy (July/August)
  • Psychoanalysis in Modern Psychiatry (June)
  • Correctional Psychiatry (May)
  • Antidepressant Roundup (April)
  • Burnout (March)
  • Private Practice (February)
  • Bipolar Disorder (January)

2015

  • Psychiatry and General Medicine (November/December)
  • Biomarkers in Psychiatry (May)
  • Telepsychiatry (October)
  • Sleep Disorders (September)
  • Interventional Psychiatry (July/August)
  • Eating Disorders (June)
  • Psychotherapy Updates (April)
  • Topics in Geriatric Psychiatry (March)
  • Antipsychotics Update (February)
  • Risk Management (January)

2014

  • Bipolar Disorder (November/December)
  • Pharmacogenetics (October)
  • Keeping up in Psychiatry (September)
  • Research in Psychiatry (July/August)
  • Marijuana (June)
  • Psychiatric Diagnosis (May)
  • Issues in Psychopharmacology (April)
  • Schizophrenia (March)
  • Women’s Psychiatry (February)
  • Ethics in Psychiatry (January)

2013

  • Military Psychiatry (December)
  • Depression (November)
  • Treatment of Dementia (October)
  • Anxiety Disorders (September)
  • Natural and Alternative Treatments in Psychiatry (July/August)
  • Autism Spectrum Disorder (June)
  • Practice Tips (May)
  • Substance Abuse (April)
  • Medicolegal Topics (March)
  • End of Life Care (February)
  • Antipsychotic Update (January)

2012

  • Screening Tools and Tips (December)
  • Medical Comorbidities (November)
  • Devices in Psychiatry (October)
  • Eating Disorders (September)
  • Bipolar Disorder (July/August)
  • Risk Management (June)
  • Antidepressant Roundup 2012 (May)
  • Gender and Sexuality (April)
  • Personality Disorders (March)
  • ADHD (February)
  • Natural Treatments in Psychiatry (January)

2011

  • Electronic Medical Records (December)
  • Insomnia (November)
  • Psychotherapy (October)
  • Alcoholism (September)
  • Anxiety Disorders (July/August)
  • Schizophrenia (June)
  • Managing Side Effects (May)
  • Antidepressant Roundup 2011 (April)
  • DSM-5 and Diagnostic Issues (March)
  • Drug-Drug Interactions (February)
  • Bipolar Disorder (January)

2010

  • Hospital Psychiatry (December)
  • Psychiatric Medication in Pregnancy (November)
  • Maintenance of Certification (October)
  • The Neuroscience of Psychotherapy (September)
  • Treatment of Depression (July/August)
  • Email and the Internet in Psychiatry (June)
  • Substance Abuse (May)
  • The Diagnosis and Treatment of Dementia (April)
  • Ethics in Psychiatry (March)
  • Natural Treatments in Psychiatry (February)
  • ADHD (January)

2009

  • Treating Schizophrenia (December)
  • Treatment for Anxiety Disorders (November)
  • The Latest on Antidepressants (October)
  • Topics in Neuropsychiatry (September)
  • The Interface of Medicine and Psychiatry (July/August)
  • Generic Medications in Psychiatry (June)
  • The Treatment of Eating Disorders (May)
  • Healthcare Policy and Psychiatry (April)
  • Antipsychotic Roundup 2009 (March)
  • Psychiatric Medication in Pregnancy and Lactation (February)
  • Transcranial Magnetic Stimulation (January)

2008

  • Treating Fibromyalgia and Pain in Psychiatry (December)
  • Issues in Child Psychiatry (November)
  • Improving Psychiatric Practice (October)
  • Treating Personality Disorders (September)
  • Bipolar Disorder (July/August)
  • Antipsychotic Roundup 2008 (June)
  • Atypical Antipsychotics in Clinical Practice (February)
  • Neuropsychological Testing (May)
  • Psychiatric Medications: Effects and Side Effects (April)
  • Update on Substance Abuse (March)
  • Anticonvulsants in Psychiatry (February)
  • Brain Devices in Psychiatry (January)

2007

  • The Treatment of Insomnia (December)
  • Avoiding Malpractice in Psychiatry (November)
  • Update on Eating Disorders (October)
  • Complex Psychopharmacology (September)
  • Laboratory Testing in Psychiatry (August)
  • Psychotherapy in Psychiatry (July)
  • Posttraumatic Stress Disorder (June)
  • Topics in Geriatric Psychiatry 2007 (May)
  • Pregnancy and Menopause in Psychiatry (Apil)
  • Antipsychotic Roundup 2007 (March)
  • Understanding Psychiatric Research (February)
  • Antidepressant Round-up 2007 (January)

2006

  • Technology and Psychiatric Practice (December)
  • The Use of MAOIs (November)
  • Medication Treatment of Depression (January)
  • Seasonal Affective Disorder (October)
  • Treatment of ADHD (September)
  • Topics in Bipolar Disorder (August)
  • Neurotransmitters in Psychiatry (July)
  • Treating Substance Abuse (June)
  • The STAR*D Antidepressant Trial (May)
  • Natural Treatments in Psychiatry (April)
  • Medication Treatment of Anxiety (March)
  • Panic Disorder: Making Treatment Work (March)
  • Antipsychotic Roundup 2006 (February)
  • Antidepressant Roundup 2006 (January)

2005

  • Self-Help Books and Psychiatry (December)
  • Genetics and Psychiatry (November)
  • Pregnancy and Psychiatric Treatment (October)
  • Benzodiazepines and Hypnotics in Psychiatry (September)
  • Geriatric Psychiatry Update (August)
  • Chart Documentation in Psychiatry (July)
  • The Treatment of Bipolar Disorder (June)
  • Weight Loss and Smoking Cessation in Psychiatry (May)
  • Treating ADHD (April)
  • Drug Industry Influence in Psychiatry (March)
  • Atypical Antipsychotics 2005 (February)
  • Antidepressant Roundup 2005 (January)

2004

  • Sexual Dysfunction (December)
  • Suicide Prevention (November)
  • To Sleep, To Awake (October)
  • Women’s Issues in Psychiatry (September)
  • OCD: An Update (August)
  • Chronic Pain and Psychiatry (July)
  • Neuroimaging in Psychiatry (June)
  • Natural Medications in Psychiatry (May)
  • Posttraumatic Stress Disorder (April)
  • Treatment of Alcoholism (March)
  • Battle of the Atypicals (February)
  • Antidepressant Roundup, 2004 (January)

2003

  • Research Methods in Psychiatry (December)
  • Antidepressants in Children (November)
  • The Treatment of Dementia (October)
  • Bipolar Disorder, Part II: The Novel Anticonvulsants (September)
  • Bipolar Disorder: The Basics (August)
  • Drug-Drug Interactions in Psychiatry (July)
  • Managing Antidepressant Side Effects (June)
  • Antidepressants in Pregnancy and Lactation (May)
  • ADHD: Medication Options (April)
  • Panic Disorder: Making Treatment Work (March)
  • Atypical Antipsychotics in Clinical Practice (February)
  • Medication Treatment of Depression (January)

2019

  • Autism in Children and Adolescents (November/December)
  • Depression in Children and Adolescents (May/June/July/August)
  • Substance Use in Children and Adolescents (September/October)
  • Trauma in Children and Adolescents (March/April)
  • Anxiety in Children and Adolescents (January/February)

2018

  • Psychotropic Risks in Children and Adolescents (May/June)
  • ADHD in Children and Adolescents (November/December)
  • Depression in Children and Adolescents (September/October)
  • Autism in Children and Adolescents (July/August)
  • Anxiety in Children and Adolescents (March/April)
  • Suicide in Children and Adolescents (January/February)

2017

  • Adolescents (November/December)
  • ADHD in Children and Adolescents (September/October)
  • Psychosis in Children and Adolescents (August)
  • PANDAS, PANS, and Related Disorders (June/July)
  • Marijuana in Children and Adolescents (May)
  • Tourette’s and Other Tic Disorders in Children and Adolescents (March/April)
  • Autism in Children and Adolescents (January/February)

2016

  • Gender Dysphoria in Children and Adolescents (November/December)
  • Technology Issues With Children and Adolescents (September/October)
  • Mood Dysregulation in Children and Adolescents (July/August)
  • Eating Disorders in Children and Adolescents (May/June)
  • Conduct Disorder in Children and Adolescents (April)
  • Sleep Disorders in Children and Adolescents (March)
  • ADHD in Children and Adolescents (January/February)

2015

  • Antidepressant Use in Children (November/December)
  • Foster Care and Child Psychiatry (September/October)
  • Autism (July/August)
  • Trauma (May/June)
  • Anxiety Disorders (April)
  • Schools and Psychiatry (March)
  • Emergency Psychiatry in Children (January/February)

2014

  • Antipsychotics in Children (December)
  • ADHD (November)
  • Gender and Sexuality (September/October)
  • Psychotic Symptoms (Summer)
  • Medication Side Effects (May)
  • Food and Mood (April)
  • Learning and Developmental Disabilities (February)

2013

  • Complex Practice Issues (December)
  • Diet and Nutrition (November)
  • Child Psychiatry in DSM-5 (August/September)
  • Medication Side Effects and Interactions (June/July)
  • Problematic Technology (March/April)
  • Autism Spectrum Disorders (January/February)

2012

  • Bipolar Disorder (December)
  • Substance Abuse (October/November)
  • Transitional Age Youth (July/August)
  • Rating Scales (May/June)
  • Eating Disorders (March/April)
  • Behavioral Disorders (February)

2011

  • Treatment of Anxiety Disorders (December)
  • Trauma (November)
  • Bullying and School Issues (October)
  • Hidden Medical Disorders (August)
  • OCD and Tic Disorders (June)
  • Suicide and Non-Suicidal Self Injury (April)
  • Sleep Disorders (March)
  • ADHD (January)

2010

  • Use of Antipsychotics in Children and Adolescents (December)
  • Learning and Developmental Disabilities (October)
  • Major Depression (September)
  • Treating Children and Families (July)
  • The Explosive Child (May)

2019

  • Dual Diagnosis in Addiction Medicine (May/June)
  • Medical Issues in Addiction Practice (November/December)
  • Alcohol Addiction (September/October)
  • Legal Issues in Addiction Medicine (July/August)
  • Traumatic Brain Injury and Addiction (March/April)
  • Board Certification in Addiction Medicine (January/February)

2018

  • Opioid Addiction (November/December)
  • Addiction in Older Adults (October)
  • Sleep Disorders and Addiction (September)
  • Adolescent Addiction (July/August)
  • Pain and Addiction (May/June)
  • Cannabis and Addiction (March/April)
  • Stigma and Addiction (January/February)

2017

  • Pregnancy and Addiction (November/December)
  • Detox (Sepember/October)
  • Dual Diagnosis (August)
  • Alternatives to 12-Step Programs (June/July)
  • Recovery (May)
  • Psychiatric Uses of Street Drugs (March/April)
  • Sex Addiction (January/February)

2016

  • Prescription Drug Monitoring Programs (PDMPs) (November/December)
  • Addiction in Health Care Professionals (September/October)
  • Dialectical Behavior Therapy in Addiction (August)
  • Motivational Interviewing (June/July)
  • Benzodiazepines (May)
  • Opioid Addiction (March/April)
  • Families and Substance Abuse (January/February)

2015

  • The Twelve Steps (November/December)
  • Designer Drugs (September/October)
  • Residential Treatment Programs Decoded (July/August)
  • Nicotine and E-Cigarettes (June)
  • Drug Screening (April/May)
  • Integrating Therapy and Medications for Alcoholism (March)
  • Detoxification Protocols (January/February)

2014

  • Behavioral Addictions (December)
  • Risk and Reimbursement (November)
  • Stimulant Abuse (September/October)
  • Self-Help Programs (June)
  • Opioid Addiction (May)
  • Coping with Bad Outcomes (March)
  • Change Management in Addiction Treatment (January/February)

2013

  • Cocaine Addiction (December)
  • Relapse Prevention (November)
  • Cannabis Addiction (August/September)
  • Addiction in DSM-5 (June/July)
Editor-in-Chief

Joshua D. Feder, MD

Dr. Joshua Feder studied mathematics and medicine at Boston University, Psychiatry at Naval Regional Medical Center San Diego, serving the first gulf war in child and adolescent psychiatry fellowship at Tripler Army Medical Center in Honolulu, and eventually becoming Chief of Child Psychiatry at the National Naval Medical Center in Bethesda, MD. Dr. Feder now practices in Solana Beach, California and serves as Medical Director at Positive Development, providing relationship-based support for families, with research at UCSD, SDSU, Fielding Graduate University, An Najah National University, Quicksilver Software, Autism Is inclusion program, and Programmatic Lead for the International Networking Group on Peace Building with Young Children, with projects in the US, Northern Ireland, and the Middle East. Dr. Feder co-authored the first American Academy of Child & Adolescent Psychiatry Practice Parameter on Autism and serves on the Disaster & Trauma Committee and the Resource Group on Youth at the Border. Dr Feder was founding policy chair for the California Association for Infant Mental Health, and advocates worldwide on access to care, climate policy, and peacebuilding. His recent books include Child Medication Fact Book for Psychiatric Practice (2018) and Prescribing Psychotropics (2021).

Full Editorial Information

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Subscriptions
  • Books
  • Online Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Child Psychiatry Report
  • The Carlat Hospital Psychiatry Report

Contact

  • info@thecarlatreport.com
  • 866-348-9279
  • PO Box 626, Newburyport MA 01950

Follow Us

© 2022 Carlat Publishing, LLC and Affiliates, All Rights Reserved.

Please see our Privacy Policy and the Hardware/Software Requirements to view our website.

×