Current Perspectives on the Pharmacologic Treatment of Pediatric Aggression

Aggressive behaviors in children and adolescents are a common reason for psychiatric referrals, yet assessment and treatment remain complicated by lack of a standardized nosology of aggression. As a result, clinical trials targeting aggression often include youth with heterogeneous underlying diagnoses, complicating cross-study comparisons and limiting generalizability. This review summarizes current evidence for pharmacologic interventions for pediatric aggression based on the underlying diagnosis. Current evidence supports the use of stimulant medications and adjunctive risperidone for youth with attention-deficit/hyperactivity disorder (ADHD) and aggression that is resistant to monotherapy with the stimulant. Risperidone, divalproex, lithium and haloperidol demonstrated benefit in reducing aggression in youth with conduct disorder. Several other antipsychotics have limited evidence for use in this population. There is preliminary evidence that suggests potential benefit for the use of clonidine for youth with ADHD and aggression. This report outlines current pharmacologic strategies and highlights the need for better targeted interventions to guide clinical decision making.