Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy

Joseph C. Blader, Nina R. Schooler, Peter S. Jensen, Steven R. Pliszka, Vivian Kafantaris

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

Objective: The purpose of the present study was to evaluate the efficacy of divalproex for reducing aggressive behavior among children 6 to 13 years old with attention deficit hyperactivity disorder (ADHD) and a disruptive disorder whose chronic aggression was underresponsive to a prospective psychostimulant trial. Method: Children received open stimulant treatment during a lead-in phase that averaged 5 weeks. Agent and dose were assessed weekly and modified to optimize response. Children whose aggressive behavior persisted at the conclusion of the lead-in phase were randomly assigned to receive double-blind, flexibly dosed divalproex or a placebo adjunctive to stimulant for 8 weeks. Families received weekly behavioral therapy throughout the trial. The primary outcome measure was the proportion of children whose aggressive behavior remitted, defined by post-trial ratings of negligible or absent aggression. Result: A significantly higher proportion of children randomly assigned to divalproex met remission criteria (eight out of 14 [57%]) than those randomly assigned to placebo (two out of 13 [15%]). Divalproex was generally well tolerated. Conclusions: Among children with ADHD whose chronic aggressive behavior is refractory to optimized stimulant treatment, the addition of divalproex increases the likelihood that aggression will remit. A larger trial is necessary to specify with greater precision the magnitude of benefit for adjuvant divalproex.

Original languageEnglish (US)
Pages (from-to)1392-1401
Number of pages10
JournalAmerican Journal of Psychiatry
Volume166
Issue number12
DOIs
StatePublished - Dec 2009

ASJC Scopus subject areas

  • Psychiatry and Mental health

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