Stepped Pharmacotherapy for Aggressive Youth with ADHD
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
- Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorderJoseph 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...
- Pharmacological treatment of bipolar disorder among children and adolescentsJoseph 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...
- Longitudinal assessment of parental satisfaction with children's psychiatric hospitalizationJoseph 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...
- Stimulant-responsive and stimulant-refractory aggressive behavior among children with ADHDJoseph 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....
- Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007Joseph 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...
- 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....
- Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004Joseph 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...
- Pharmacotherapy and postdischarge outcomes of child inpatients admitted for aggressive behaviorJoseph 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....
- Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapyJoseph C Blader
Stony Brook University School of Medicine, Stony Brook, NY 11794 8790, USA
Am J Psychiatry 166:1392-401. 2009....
- 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...