Skip to main content
SpringerLink
Log in

Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

This study examined the association between acute aggressive behavior patterns of 145 adolescents in residential treatment facilities with use of and changes in antipsychotic medication for the chronic management of aggression. Seclusion/restraint (S/R) frequency over 12 months was used to categorize youth into none, low, moderate, and high S/R groups. Data were analyzed using longitudinal mixed effects logistic regression models that allowed for intra-subject variability over time. The high and moderate S/R groups were significantly more likely to receive antipsychotics, get higher doses, and have changes in medication compared with the none S/R group. Increases in antipsychotic dose were associated with a lower likelihood of changes in antipsychotic medication over time. Despite persistent antipsychotic use at higher doses, youth in the high and moderate S/R groups continued to be secluded/restrained frequently. The findings question the adequacy of these medications in managing aggressive behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

References

  1. Olfson M, Blanco C, Liu L, et al. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Archives of General Psychiatry. 2006;63:679–685.

    Article  PubMed  Google Scholar 

  2. Matone M, Localio R, Huang YS, et al. The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: A national study of U.S. medicaid-enrolled children. Health Services Research. 2012;47:1836–1860.

    Article  PubMed  Google Scholar 

  3. Olfson M, Blanco C, Liu SM, et al. National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Archives of General Psychiatry. 2012; (online) E1–E10.

  4. Correll, CU, Penzner JB, Parikh UH, et al. Recognizing and monitoring adverse events of second-generation antipsychotics in children and adolescents. Child and Adolescent Psychiatric Clinics of North America. 2005;15:177–206.

    Article  Google Scholar 

  5. Staller JA, Wade MJ, Baker M. Current prescribing patterns in outpatient child and adolescent psychiatric practice in Central New York. Journal of Child and Adolescent Psychopharmacology. 2005;15:57–61.

    Article  PubMed  Google Scholar 

  6. Cooper WO, Hickson GB, Fuchs C, et al. New users of antipsychotic medications among children enrolled in Tenncare. Archives of Pediatric and Adolescent Medicine. 2004;158:753–759.

    Article  Google Scholar 

  7. Crystal S, Olfson M, Huang C, et al. Broadened use of atypical antipsychotics: Safety, effectiveness, and policy changes. Health Affairs. 2009;28:w770–w781.

    Article  PubMed  Google Scholar 

  8. Domino MA and Swartz MS. Who are the new users of antipsychotic medications? Psychiatric Services.2008;59:507–514.

    Article  PubMed  Google Scholar 

  9. Connor DF, Ozbayrak KR, Harrison RJ, et al. Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology. 1998;8:27–38.

    Article  PubMed  CAS  Google Scholar 

  10. Rawal PH, Lyons JS, MacIntyre II JC, et al. Regional variation and clinical indicators of antipsychotic use in residential treatment: A four-state comparison. The Journal of Behavioral Health Services and Research. 2004; 31:178–188.

    Google Scholar 

  11. Folz R. The efficacy of residential treatment: An overview of the evidence. Residential Treatment for Children & Youth. 2004; 22:1–19.

    Article  Google Scholar 

  12. Seida JC, Schouten JR, Boylan K, et al. Antipsychotics for children and young adults: A comparative effectiveness review. Pediatrics. 2012; 129: e771–e784.

    Article  PubMed  Google Scholar 

  13. Pfeifer JC, Kowatch RA, DelBello MP. Pharmacotherapy of bipolar disorder in children and adolescents. CNS Drugs. 2010; 24: 575–593.

    Article  PubMed  CAS  Google Scholar 

  14. Elbe D, Lalani Z. Review of the pharmacotherapy of irritability of autism. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2012; 21:130–146.

    PubMed  Google Scholar 

  15. Schur SB, Sikich L, Findling RL, et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part I: A review. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42: 132–44.

    Article  PubMed  Google Scholar 

  16. Findling, RL. Atypical antipsychotic treatment of disruptive behavior disorders in children and adolescents. The Journal of Clinical Psychiatry. 2008;69:9–14.

    Article  PubMed  CAS  Google Scholar 

  17. Pappadopulos E, MacIntyre II JC, Crismon ML, et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42:145–61.

    Article  PubMed  Google Scholar 

  18. Barnett SR, dosReis S, Riddle MA, et al. Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youth. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41:897–905.

    Article  PubMed  Google Scholar 

  19. dosReis S, Barnett S, Love RC, et al., Maryland Youth Practice Improvement Committee. A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities. Psychiatric Services. 2003;54:1357-1363.

    Article  PubMed  Google Scholar 

  20. dosReis S, Davarya S. Staff perspectives of precipitants to aggressive behavior of adolescents in residential treatment facilities. Residential Treatment for Children and Youth. 2008;25:85-101.

    Article  Google Scholar 

  21. dosReis S, McCulloch J, Colantuoni E, et al. Early identification of seclusion and restraint patterns during adolescents’ course of residential treatment. Residential Treatment for Children and Youth. 2010; 27:160-174.

    Article  Google Scholar 

  22. Leidy BD, Haugaard JJ, Nunno MA, et al. Review of restraint data in a residential treatment center for adolescent females. Child Youth Care Forum. 2006; 35;339–352.

    Article  Google Scholar 

  23. Beck NC, Durret C, Stinson J, et al. Trajectories of seclusion and restraint use at a state psychiatric hospital. Psychiatric Services. 2008; 59:1027–1032.

    Article  PubMed  Google Scholar 

  24. Sadock BJ, Sadock VA. Pocket Handbook of Psychiatric Drug Treatment. Philadelphia: Lippincott Williams and Wilkins; 2001:114.

    Google Scholar 

  25. Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. The Journal of Clinical Psychiatry. 2003;64:663–667.

    Article  PubMed  CAS  Google Scholar 

  26. Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics. 2001; 57:120–125.

    Article  PubMed  CAS  Google Scholar 

  27. Ebesutani C, Ale C, Luebbe A, et al. A practical guide for implementing evidence-based assessment in a psychiatric residential treatment facility: Translating theory into practice. Residential Treatment for Children & Youth. 2011; 28:211–231.

    Article  Google Scholar 

  28. Rappaport N, Thomas C. Recent findings on aggressive and violent behavior in youth: Implications for clinical assessment and intervention. Journal of Adolescent Health. 2004;35:260–277.

    PubMed  Google Scholar 

  29. Connor DF, Anderson JJ, Steingard RJ, et al. Proactive and reactive aggression in referred children and adolescents. The American Journal of Orthopsychiatry. 2004;74:129–136.

    Article  PubMed  Google Scholar 

  30. Jensen PS, Youngstrom EA, Steiner H, et al. Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: Implications for medication studies. Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46:309–322.

    Article  PubMed  Google Scholar 

  31. King A, Waschbusch DA, Pelham WE, et al. Subtypes of aggression in children with attention deficit hyperactivity disorder: Medication effects and comparison with typical children. Journal of Clinical Child and Adolescent Psychology. 2009; 38: 619–629.

    Article  PubMed  Google Scholar 

  32. Blader JC, Schooler NR, Jensen PS, et al. Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy. American Journal of Psychiatry. 2009;166:1392–1401.

    Article  PubMed  Google Scholar 

  33. Connor DF, Chartier KG, Preen EC, et al. Impulsive aggression in attention-deficit/hyperactivity disorder: Symptom severity, co-morbidity, and attention-deficit/hyperactivity disorder subtype. Journal of Child and Adolescent Psychopharmacology. 2010;20:119–126.

    Article  PubMed  Google Scholar 

  34. Dangel RF, Deschner JP, Rasp CR. Anger control training for adolescents in residential treatment. Behavior Modification. 1989;13:447–458.

    Article  PubMed  CAS  Google Scholar 

  35. Larson JD, Calamari JE, West JG. Aggression management with disruptive adolescents in the residential setting: Integration of a cognitive–behavioral component. Residential Treatment for Children and Youth. 1998; 15: 1–9.

    Article  Google Scholar 

  36. McDonell MG, Tarantino J, Dubose AP, et al. A pilot evaluation of dialectical behavioural therapy in adolescent long-term inpatient care. Child and Adolescent Mental Health. 2010; 15:193–196.

    Article  Google Scholar 

  37. Little L, Butler L and Fowler J. Change from the ground up: Bringing informed-dialectical behavioral therapy to residential treatment. Residential Treatment for Children & Youth. 2010; 27:80–91.

    Article  Google Scholar 

  38. Huefner JC, Griffith AK, Smith GL et al., Reducing psychotropic medications in an intensive residential treatment center. Journal of Child and Family Studies. 2012. doi:10.1007/s10826-012-9628-7

  39. Hair H. Outcomes for children and adolescents after residential treatment: A review of research from 1993–2003. Journal of Child and Family Studies. 2005;14:551–575.

    Article  Google Scholar 

  40. Knorth EJ, Harder AT, Zandberg T, et al. Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children and Youth Services Review. 2008; 30:123–140

    Article  Google Scholar 

  41. www.aacrc-dc.org. AACRC Position Paper-Fifth in Series: Evidence Based Practices

  42. www.aacrc-dc.org. AACRC Position Paper-Ninth in Series: Measuring Functional Outcomes

Download references

Acknowledgments

We are grateful for the support of Dr. Brian Hepburn, Director, Maryland Mental Hygiene Administration (MHA); Gayle Jordan-Randolph, M.D., Jean Smith, M.D., Holly Sikoryak, M.D., David Horn, M.D. (Child Mental Health Institute for Children and Adolescents) (MHA); Eileen Hansen, LCSW, Ruth Anne McCormick, RN, C., DNSc, (University of Maryland); and Jane Walker (Maryland Coalition of Families for Children’s Mental Health). The authors are grateful to Sarah Davarya for her assistance with the data collection. This work was made possible through the financial support of the Maryland Mental Hygiene Administration (D Pruitt, M Riddle, PI) and T32 MH20033-10 (M Riddle, PI).

Conflict of Interest

The authors report no conflicts of interest.

Author information

Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 4940 Eastern Avenue, D2E, Baltimore, MD, 21224, USA

    Leslie Miller MD

  2. Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, Children’s Center 12th Floor, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Mark A. Riddle MD

  3. Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 W. Pratt Street, 4th Floor, Baltimore, MD, 21201, USA

    David Pruitt MD

  4. Maryl and Mental Hygiene Administration Spring Grove Hospital Center, 55 Wade Avenue, Catonsville, 21228, MD, USA

    Al Zachik MD

  5. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-220, Baltimore, MD, 21201, USA

    Susan dosReis PhD

Authors
  1. Leslie Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark A. Riddle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Pruitt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Al Zachik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Susan dosReis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan dosReis PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miller, L., Riddle, M.A., Pruitt, D. et al. Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities. J Behav Health Serv Res 40, 97–110 (2013). https://doi.org/10.1007/s11414-012-9314-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-012-9314-y

Keywords

Search

Navigation