Children and adolescents with certain severe disruptive behavior disorders that are marked by explosive temper caused by irritable mood swings demonstrated significant behavior improvement when treated with the anti-convulsant divalproex (Depakote), according to a preliminary study briefly reported in the May issue of the American Journal of Psychiatry.
In the joint New York State Psychiatric Institute, Columbia University study of twenty outpatients ages 10 to 18 who met specific criteria for explosive temper and mood variations, researchers found that 80% or more of those receiving the medication responded positively and with improved behavior and responses. "These are kids who cannot control their behavior, who get placed in special education classes from an early age, who don't get exposed to normal kids their own age, and who are deprived of normal socialization experiences," said lead researcher Stephen J. Donovan, M.D.
"Since children and adolescents with disruptive disorders are at high risk for delinquency and addiction, identifying a subgroup that can be helped with medications as part of their comprehensive psychosocial treatment, could have major public health implications," Dr. Donovan added. "Explosive behavior among a small number of children and youth is a significant problem in our schools and communities and deserves further research. This study suggests that a particular type of disruptive behavior -- characterized by explosive temper driven by irritable mood -- may have a biological component that responds positively to anti-convulsant medications." Dr. Donovan said the double-blind placebo-controlled crossover study did not evaluate use of the medication in other forms of disruptive behavior, and did not examine the long term consequences of its use.
Herbert Sacks, M.D., noted Yale child and adolescent psychiatrist and a past President of the APA, cautioned that the study, while promising, is preliminary. He noted that identifying disruptive children who met criteria used in the divalproex study "requires a comprehensive evaluation by an experienced child and adolescent psychiatrist with appropriate consideration of the dynamics within the family and important input from the school and pediatrician. In treating disruptive disorders and other disorders of children, medication must never be used alone, but as part of a treatment plan that involves psychosocial interventions including psychotherapy."
Dr. Sacks warned that "the rash use of an off-label medication could possibly lead us into situations where educators and distraught parents pressure psychiatrists and other physicians to prescribe medication without a full diagnostic evaluation, without monitoring, and without adequate scientific evidence of safety and effectiveness."
NOTE: The American Psychiatric Association publication "Fact Sheet: Children, Mental Health and Medicines," is available on-line at http://www.psych.org/public_infor. The American Psychiatric Association is a national medical specialty society that represents nearly 40,000 psychiatric physicians specializing in the diagnosis, treatment and prevention of mental illnesses and substance use disorders.
Journal
American Journal of Psychiatry