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...

Carlat - Integrative Approach to Assessing ADHD

In this tip, excerpted from a past issue of the Carlat Child Psychiatry Report, Elizabeth Tien, MD, a child & adolescent psychiatrist at Maimonides Medical Center in Brooklyn, NY, offers off-label advice on prescribing medications for children with PTSD. B

Carlat - Managing Conflict Over Medication Consent

The following tips for overcoming conflict in the medication consent process were excerpted from an article I wrote for the May/June issue of the Carlat Child Psychiatry Report: If it’s not an emergency, take your time.