Seizure drug limits aggression in kids with ADHD

If your child with attention deficit hyperactivity disorder (ADHD) is having trouble controlling his aggressive behaviors, adding a drug commonly used to treat seizures and manic depression may help, according to a small new study.

Doctors typically use stimulants such as Ritalin (methylphenidate) and Adderal (a combination of amphetamines) to treat the main symptoms of ADHD. But some children are still aggressive even when those symptoms disappear, according to study co-author Dr. Joseph C. Blader, from Stony Brook University School of Medicine, New York, and colleagues.

In their study, Blader’s team decided to try the anti-seizure drug divalproex, which has been shown to reduce aggression in children and adolescents with a variety of psychiatric disorders. In the American Journal of Psychiatry for December, they report on 30 ADHD patients, 6 to 13 years of age, with aggression that did not respond to stimulants.

Half of the children received divalproex in addition to their regular ADHD treatment, while half received a placebo, or inactive, pill, plus their usual medications. All of the children’s families had weekly behavioral therapy.

Three of the children either left the study before it was completed, or could not be found for follow-up testing. Eight of 14 patients in the divalproex group exhibited less aggressive behavior, compared to just 2 of 13 in the placebo group.

Although the drug was generally well-tolerated, some children taking it experienced feelings of sadness and trouble falling asleep.

The study could point the way toward better combinations of medications for ADHD, Dr. Hans Steiner and Dr. Niranjan S. Karnik, from Stanford University, California, write in a related editorial.

SOURCE: American Journal of Psychiatry, December 2009.