State of New Jersey, Department of Health and Senior Services, Trenton, New Jersey, USA.
Pediatrics. 2012 Jun;129(6):e1577-86. doi: 10.1542/peds.2010-1361. Epub 2012 May 28.
To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management.
Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an expert survey of recommended practices; a consensus conference of researchers, policymakers, clinicians, and family advocates; and review by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth guidelines reflect a synthesis of the available evidence, based on this multistep process.
This article describes the content, rationale, and evidence for 11 recommendations. Key treatment principles include considering psychosocial interventions, such as evidence-based parent and child skills training as the first line of treatment; targeting the underlying disorder first following evidence-based guidelines; considering individual psychosocial and medical factors, including cardiovascular risk in the selection of agents if medication treatment (ideally with the best evidence base) is initiated; avoiding the use of multiple psychotropic medications simultaneously; and careful monitoring of treatment response, by using structured rating scales, as well as close medical monitoring for side effects, including metabolic changes.
Treatment of children with maladaptive aggression is a "moving target" requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.
制定青少年适应不良攻击行为的管理和治疗指南，涵盖心理社会干预、药物治疗和副作用管理等领域。
通过系统文献回顾、专家推荐实践调查、研究人员、政策制定者、临床医生和家庭倡导者共识会议以及指导委员会对建议草案的连续审查，多步骤地汇集和评估证据。基于这一多步骤过程，中心制定了心理健康治疗青少年适应不良攻击行为的指南，反映了现有证据的综合情况。
本文描述了 11 项建议的内容、原理和证据。关键治疗原则包括考虑心理社会干预，如基于证据的父母和儿童技能培训作为一线治疗；根据循证指南首先针对潜在疾病；考虑个体心理社会和医疗因素，包括在选择药物治疗（最好基于最佳证据）时，如果有心血管风险，则考虑个体因素；避免同时使用多种精神药物；以及通过使用结构化评分量表以及密切的医疗监测副作用（包括代谢变化），密切监测治疗反应。
治疗适应不良攻击行为的儿童是一个“移动目标”，需要不断吸收新出现的证据。基于现有证据，青少年适应不良攻击行为治疗指南为青少年适应不良攻击行为的管理提供了一个框架，适合初级保健临床医生和心理健康提供者使用。
