Carlat - Antipsychotics and Aggressive Children With ADHD

The TOSCA study focused on children with severe ADHD, who also met criteria for oppositional defiant disorder (ODD) or conduct disorder (CD). These children tend not to do as well with stimulants alone and often end up being prescribed antipsychotics, typically second generation antipsychotics (SGA’s). TOSCA was devised to help clinicians determine when/if to use an antipsychotic (Barterian JA et al, J Am Acad Child Adolesc Psychiatry2017;56(12):1026–1033).

Writing in the July/August issue of The Carlat Child Psychiatry ReportCandace Good, MD, outlines the following recommendations from the TOSCA findings, which we hope you’ll find useful:

Bottom line
For patients with severe disruptive symptoms, proceed carefully and avoid jumping to antipsychotics. Push for parent training and, when indicated, CBT. The side effects of risperidone and the lack of data on other antipsychotics in this situation are problematic. Moreover, our patients often have mood and developmental challenges that were excluded in TOSCA and likely limit the benefit of this approach.

To read the full article in The Carlat Child Psychiatry Reportclick here. Not a subscriber? Join here.

Author
Joshua Feder, M.D. Dr. Feder's Blog

You Might Also Enjoy...

Duty to Warn: Antidepressants in Children and Adolescents

For 17 years, since the FDA black box warning about suicidality with antidepressants, our community has quoted data that downplays this concern. We were wrong. We were deceived. Antidepressants can be lifesaving, but there really is a duty to warn.

Affect Autism - Accept Reality?

Returning guest Dr. Joshua Feder and I discuss why it is so important to emphasize that accepting reality is a process that parents need to be supported in, and the ways in which we can do this.

Reimagining ADHD with Ned Hallowell

While medication is the mainstay of treating symptoms in ADHD, Edward Hallowell, MD, shares a positive, relationship-based approach to ADHD with practical strategies to help children and adolescents manage ADHD.

Air Quality and Mental Health

Air pollution, including particulate matter from forest fires, is a leading cause of health problems. It is also linked to psychiatric problems in children and adolescents. We take a closer look at the evidence and clinical implications in this episode.

Addressing Systemic Inequity

We hope this trio of 60-second psych podcasts is a start at addressing the impact of systemic inequity: How to Address Implicit Bias Promoting Assertiveness in Adolescents Preventing Trauma With Racial Socialization