Stepped Pharmacotherapy for Aggressive Youth with ADHD

Summary

Principal Investigator: JOSEPH BLADER
Abstract: DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award is to promote the candidate's progress toward an independent scientific career focused on treatment strategies for youth with severe disruptive disorders. Didactics and apprenticeship in interventions research skills in Year 1 will prepare the candidate to initiate a study of stepped pharmacotherapy for aggressive youth with attention-deficit/hyperactivity disorder (ADHD). This study, conducted in Years 2, 3 and part of 4, will a) provide the candidate with supervised experience in controlled treatment research, and b) address the critical need for rigorous trials to examine if combined medication approaches improve outcomes over monotherapy in this patient group. Childhood aggressive behavior most often develops alongside other disruptive disorder symptoms, which are highly comorbid with ADHD. Stimulant medication is first-line treatment for ADHD. Yet, for many children receiving stimulant treatment, aggressive behavior and affective instability remain significant impairments, leading clinicians to layer additional medications in efforts to diminish aggressive dyscontrol. However, the lack of evidence to support any medication combination strategy for these children is a great concern. The proposed study will first optimize open stimulant treatment for aggressive children 6- 12 years old with ADHD and a comorbid disruptive disorder. Children whose ADHD symptoms benefit from stimulant treatment but whose aggression persists will be randomly assigned to the mood stabilizer divalproex sodium or placebo during an 8-week double-blind trial while their stimulant treatment continues. All families will receive structured psychosocial treatment. The study will furnish preliminary data to enable a full-scale efficacy study, supported through an R01 to be submitted in Year 4. Further training activities throughout the award period will equip the candidate with research skills and provide experience in the areas of: a) intervention trial design and statistics, b) development and adoption in clinical settings of treatment strategies, including combined medication and psychosocial treatment, and c) assessment, including observational and laboratory approaches to outcome and mediator measurement. Mentors (N. Schooler, P. Jensen, V. Kafantaris) and consultants (including H. Abikoff, P. Frick, C. Grillon, J. Halperin, J. Kane, D. Kolko, S. Pliszka) will provide expert training and supervision. The proposed program will therefore culminate in the awardee's competence as a well-rounded clinical scientist focused on the complex treatment needs of youth with severe behavior disorders.
Funding Period: 2002-09-19 - 2009-03-31
more information: NIH RePORT

Top Publications

  1. ncbi Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder
    Joseph C Blader
    University of Texas Health Science Center HSC at San Antonio North Shore Long Island Jewish LIJ Health System Electronic address
    J Am Acad Child Adolesc Psychiatry 52:1281-93. 2013
  2. pmc Pharmacological treatment of bipolar disorder among children and adolescents
    Joseph C Blader
    Stony Brook State University of New York, NY, USA
    Expert Rev Neurother 7:259-70. 2007
  3. pmc Longitudinal assessment of parental satisfaction with children's psychiatric hospitalization
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, School of Medicine, Stony Brook State University of New York, Stony Brook, NY 11794 8790, USA
    Adm Policy Ment Health 34:108-15. 2007
  4. pmc Stimulant-responsive and stimulant-refractory aggressive behavior among children with ADHD
    Joseph C Blader
    Stony Brook State University of New York, Department of Psychiatry and Behavioral Science, Putnam Hall, Room 139, Stony Brook, NY 11794 8790, USA
    Pediatrics 126:e796-806. 2010
  5. ncbi Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook University, State University of New York, School of Medicine, Stony Brook, USA
    Arch Gen Psychiatry 68:1276-83. 2011
  6. pmc Which family factors predict children's externalizing behaviors following discharge from psychiatric inpatient treatment?
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, 11794 8790, USA
    J Child Psychol Psychiatry 47:1133-42. 2006
  7. pmc Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, Stony Brook, New York 11794 8790, USA
    Biol Psychiatry 62:107-14. 2007
  8. pmc Pharmacotherapy and postdischarge outcomes of child inpatients admitted for aggressive behavior
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, School of Medicine, Stony Brook, NY 11794, USA
    J Clin Psychopharmacol 26:419-25. 2006
  9. pmc Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy
    Joseph C Blader
    Stony Brook University School of Medicine, Stony Brook, NY 11794 8790, USA
    Am J Psychiatry 166:1392-401. 2009
  10. pmc Can keeping clinical trial participants blind to their study treatment adversely affect subsequent care?
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, Stony Brook, NY 11794 8790, USA
    Contemp Clin Trials 26:290-9. 2005

Scientific Experts

Detail Information

Publications11

  1. ncbi Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder
    Joseph C Blader
    University of Texas Health Science Center HSC at San Antonio North Shore Long Island Jewish LIJ Health System Electronic address
    J Am Acad Child Adolesc Psychiatry 52:1281-93. 2013
    ..This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy...
  2. pmc Pharmacological treatment of bipolar disorder among children and adolescents
    Joseph C Blader
    Stony Brook State University of New York, NY, USA
    Expert Rev Neurother 7:259-70. 2007
    ..By summarizing current research and opinion on diagnostic issues and treatment approaches, this review aims to provide an update on a clinically important yet controversial topic...
  3. pmc Longitudinal assessment of parental satisfaction with children's psychiatric hospitalization
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, School of Medicine, Stony Brook State University of New York, Stony Brook, NY 11794 8790, USA
    Adm Policy Ment Health 34:108-15. 2007
    ..To examine trends over time in parents' satisfaction with their children's prior psychiatric hospitalization and whether such trends are related to postdischarge outcomes...
  4. pmc Stimulant-responsive and stimulant-refractory aggressive behavior among children with ADHD
    Joseph C Blader
    Stony Brook State University of New York, Department of Psychiatry and Behavioral Science, Putnam Hall, Room 139, Stony Brook, NY 11794 8790, USA
    Pediatrics 126:e796-806. 2010
    ....
  5. ncbi Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook University, State University of New York, School of Medicine, Stony Brook, USA
    Arch Gen Psychiatry 68:1276-83. 2011
    ..Patient-level factors, including age, admission type, diagnoses, length of stay, and payment source, are vital to understanding hospitalization trends...
  6. pmc Which family factors predict children's externalizing behaviors following discharge from psychiatric inpatient treatment?
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, 11794 8790, USA
    J Child Psychol Psychiatry 47:1133-42. 2006
    ....
  7. pmc Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, Stony Brook, New York 11794 8790, USA
    Biol Psychiatry 62:107-14. 2007
    ..These difficulties are increasingly conceptualized as bipolar disorder (BD). The impact of doing so on clinical diagnoses in clinical care is uncertain...
  8. pmc Pharmacotherapy and postdischarge outcomes of child inpatients admitted for aggressive behavior
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, School of Medicine, Stony Brook, NY 11794, USA
    J Clin Psychopharmacol 26:419-25. 2006
    ....
  9. pmc Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy
    Joseph C Blader
    Stony Brook University School of Medicine, Stony Brook, NY 11794 8790, USA
    Am J Psychiatry 166:1392-401. 2009
    ....
  10. pmc Can keeping clinical trial participants blind to their study treatment adversely affect subsequent care?
    Joseph C Blader
    Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, Stony Brook, NY 11794 8790, USA
    Contemp Clin Trials 26:290-9. 2005
    ..In the long-run, research on the impact that keeping subjects uninformed about study treatment has on post-study patient outcomes and on study integrity can foster the development of procedures that optimally balance both...