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Psychopharmacology and Aggression

II. A Meta-Analysis of Nonstimulant Medication Effects on Overt Aggression-Related Behaviors in Youth with SED

Division of Child and Adolescent Psychiatry at the University of Massachusetts Medical School daniel.connor{at}umassmed.edu

R. Thomas Boone

St. John's University

Ronald J. Steingard

Division of Child and Adolescent Psychiatry at the University of Massachusetts Medical School

Ivan D. Lopez

University of Massachusetts Medical School

Richard H. Melloni, JR

Department of Psychology at Northeastern University

The authors used meta-analysis to determine the effect size for nonstimulant medications on symptoms of overt aggression-related behaviors in referred children and adolescents with serious emotional and behavioral disturbances.A review of the literature between 1970 and 2001 revealed 33 studies meeting exclusion/inclusion criteria and yielding 37 independent effects for neuroleptic, atypical antipsychotic, mood stabilizer, antidepressant, and adrenergic agents on symptoms of overt aggression.To acquire statistical power, two groups of medications were created and analyzed.The first group consisted of medications for more severely ill children and included neuroleptics, atypical antipsychotics, and mood stabilizers.The second group consisted of medications for less severely ill children and included antidepressants and adrenergic agents. Overall weighted mean effect sizes were moderate to large for overt aggression within a heterogeneous group of psychiatric disorders. Moderators of effect size included drug group, study design, and the interaction between drug group and study design.The results support the common clinical practice of including medications as part of a comprehensive psychoeducational treatment plan for some youth with maladaptive overt aggression within a variety of psychiatric disorders; however, not all referred youth respond to medication for overt aggression-related behavior, supporting the use of additional nonmedication interventions. Future pharmacological research should attempt to identify specific classes of psychiatric medications that are effective for specifically defined types of aggression in distinct psychiatric disorders.

Journal of Emotional and Behavioral Disorders, Vol. 11, No. 3, 157-168 (2003)
DOI: 10.1177/10634266030110030301


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