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Presented by : Tzu Min Lee Radford University

A Meta-Analysis of Non-stimulant Medication Effects on Overt Aggression-Related Behaviors in Youth with SED by Daniel F. Connor, R. Thomas Boone, Ronald J. Steingard, Ivan D. Lopez, & Richard H. Melloni, Jr. Presented by : Tzu Min Lee Radford University.

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Presented by : Tzu Min Lee Radford University

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  1. A Meta-Analysis of Non-stimulant Medication Effects on Overt Aggression-Related Behaviors in Youth with SEDbyDaniel F. Connor, R. Thomas Boone, Ronald J. Steingard, Ivan D. Lopez, & Richard H. Melloni, Jr. Presented by: Tzu Min Lee Radford University

  2. Purpose • To determine the effect size for non-stimulant medications on symptoms of overt aggression-related behaviors in referred children and adolescents with serious emotional and behavioral disturbances. - Prevalence of pharmacological interventions - Overall efficacy of medications to treat aggression unclear - A literature review back to 1955 revealed no other meta-analysis except one in 2002 to assess the effects of stimulant medications on overt and covert aggression in youth with ADHD

  3. Issues to Consider • How is medications determined? - used to treat aggression-related behaviors in youth with developmental delay, ADHD, CD, depression, schizophrenia, anxiety disorders, bipolar disorder and tic disorders • How is aggression-related behaviors defined? - why overt aggression - defined broadly to be consistent with the multiplicity of aggression problems faced by clinicians in practice

  4. Literature Review • 1970-2001 medical & behavioral science • Methods - Electronic Sources * Medline * PsycInfo * Pub Med - Journal bibliographies • Studies - 41 were found - 33 met the inclusion/exclusion criteria

  5. Studies to Include • Report quantitative data on independent drug effects (neuroleptics, atypical antipsychotics, mood stabilizers, antidepressants and adrenergic agents) • Published in peer-reviewed scientific journal • Use a placebo control either in cross-over or parallel-group methodological design • Have a mean sample age of 19 years or younger • Use a valid rating scale or method of observation to assess aggression-related behaviors • Open studies, case reports and review articles are excluded.

  6. Dependent Measures • Overt aggression-related behaviors - physical assault, verbal threats, oppositional and defiant behavior, noncompliance, rule defiance, malicious teasing of others, conduct problems, disruptive behavior, poor self-control, explosive outbursts of property destruction, temper tantrums, hyperactivity/impulsivity, explosive rage attacks, hostility, and/or irritability

  7. Dependent Measures • Clinician Rating -Brief Psychotic Rating Scale (BPRS) -Children’s Psychiatric Rating Scale (ChPRS) - Rating Scale of Abnormal Behavior Checklist (RSABC) • Parent Rating - Conners Parent/Teacher Rating Scale (CPRS & CPRS) • Teacher Rating - Teachers Self-Control rating Scale (TSCRS) • Overall Rating - Average of effects for all reporters in each given study

  8. Results*p < .0001for all ratings

  9. Potential Moderators • Mean sample age • Percentage of boys in the sample • Drug group - neuroleptics, atypical antipsychotics and mood stabilizers - antidepressants and adrenergic agents • Study design - within-subjects - between-subjects • Interaction between drug type & study design

  10. Results – Moderators Drug Group, Study Design and their Interaction

  11. Study Limitations • Limitations of the extant published literature - small sample sizes, absence of drug use means and standard deviations • Grouping medications to increase statistical power diminished the precision of analysis • Risk of inflating Type 1 error by combining diverse ratings within an individual study into a single rating • Haloing effects of medication improvements on core features of psychiatric disorders

  12. Clinical Implications • Results support the continued use of medication therapy as part of a multimodal treatment plan. • Parent ratings of their children did not entirely endorse medication interventions as always effective • Benefits of medical interventions must be balanced with their potential risks. • Need for a thorough, multidisciplinary psycho- educational evaluation since overt aggression is heterogeneous in etiology. • Treatment plans must consider diverse psychosocial family, individual, community, educational, and psychopharmacological treatment interventions.

  13. Future Research • A need for continued, comprehensive research • Define aggressive behavior explicitly • Examine drug effects on certain types of aggression - physical assault, reactive aggression, proactive aggression, covert aggression, CD/ODD • Investigate social validity measures - effects of drugs on quality-of-life measures for child and family

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