Pharmacotherapeutic intervention in impulsive preschool children: The need for a comprehensive therapeutic approach

Impulsive and aggressive behaviour symptoms often are serious problems in children, even already at preschool age. Thus, effective treatment approaches are requested. In this comment pharmacotherapeutic treatment approaches, first of all risperidone, their limitations and alternative psychotherapeutic approaches are outlined

Heart rate and treatment effect in children with disruptive behavior disorders

OBJECTIVE: To examine whether children with disruptive behavior disorders (DBDs; hyperkinetic conduct disorder, conduct disorder, hyperkinetic disorder) characterized by low heart rate profit less from an intensive cognitive behavioral intervention aimed at reducing impulsive, oppositional and aggressive behavior problems. METHOD: Basal heart rate was studied in twenty-three children (aged 7-12 years) with DBD at the beginning of intervention comprising an intensive day-care treatment and parent training. The disruptive behavior of the child was assessed before treatment and after termination (12 weeks later). Therapy responders and non-responders were compared in regard to heart rate and other risk factors (cognitive functioning and socio-economic status). RESULTS: Statistical analyses yielded evidence for a significant reduction of disruptive problem behaviors (aggression, delinquency) that is more prominent in DBD children with high heart rate scores compared to patients with low heart rate scores. Heart rate was significantly lower in children who did not profit from therapy. A logistic regression analysis revealed that heart rate is a significant predictor for therapy success whereas other risk factors had no impact on therapy success. CONCLUSION: Further studies investigating biological and psychosocial predictors of treatment effectiveness are necessary. In addition, it might be helpful to consider different subtypes of aggressive behavior for selecting the best possible treatment options

Aggression in children and adolescents

Aggressive behaviour is a common phenomenon during childhood and adolescence, but at the same time it is an important associated feature of many psychiatric disorders during this age period. Persistent aggression is related to a variety of negative outcomes in adulthood, including low socioeconomic status and unemployment, criminal behaviour and social isolation. The great heterogeneity of aggressive behaviour still hampers our understanding of causal mechanisms. Still, over the past years, the identification of specific subtypes of aggression has opened possibilities for new and individualized treatment approaches. This article provides information on different subtypes of aggression in children and adolescents, on individual differences that contribute to aggression during development and on possible underlying processes related to aggressive behaviour in young people. Current treatment approaches as well as new emerging treatment possibilities are discussed