1 Boring Old Man

Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Disruptive Behaviors in Children With Subaverage Intelligence
^{by Michael G. Aman, Ph.D., Goedele De Smedt, M.D., Albert Derivan, M.D., Ben Lyons, Ph.D., Robert L. Findling, M.D., and the Risperidone Disruptive Behavior Study Group}
American Journal of Psychiatry 2002 159:1337-1346.

^{Received Aug. 1, 2001; revision received March 20, 2002; accepted April 3, 2002. From the Nisonger Center UAP, Ohio State University; the Janssen Research Foundation, Beerse, Belgium, and Titusville, N.J.; and the Departments of Psychiatry and Pediatrics, Case Western Reserve University, Cleveland. Address reprint requests to Dr. Aman, Nisonger Center UAP, Ohio State University … Supported by the Janssen Research Foundation.}

 

^{Background: Despite the increasing recognition of bipolar disorder in childhood, there have been no controlled, randomized clinical trials of atypical antipsychotics in this population. Preliminary data from openlabel trials in children suggest that these agents might be effective in treating pediatric bipolar disorder, however.}

This study started off being about medicating disruptive, low IQ kids for behavior control with Antipsychotics. It was later revived as treating "bipolar" kids. And it looks like the shots were being called from Janssen corporate offices with Biederman and the Harvard group added on for prestige.

http://clinicaltrials.gov/ct2/show/NCT00266552
http://www.trialscentral.org/astudyofthesafet-condtrid-20450.htm

^{Primary Outcome Measures: Change in the Conduct Problem subscale of the Nisonger Child Behavior Rating Form [N-CBRF] at end of treatment compared with baseline}
^{Secondary Outcome Measures: Changes in Aberrant Behavior Checklist [ABC], Behavioral Problems Inventory [BPI], and Clinical Global Impression [CGI] at end of treatment compared with baseline; incidence of adverse events throughout study}
^{Enrollment: 118}
^{Study Completion Date: October 1998}

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^{Detailed Description: Conduct and psychiatric disorders are found among a higher proportion of people with mental retardation than among people who are not mentally retarded. Among the many different treatment approaches to conduct disorder are drug therapy, behavioral treatment, psychotherapy, and training for cognitive and social skills. Studies have suggested that neuroleptic drugs, such as risperidone, may be beneficial in treating conduct disorder in mental retardation. This is a randomized, double-blind, placebo-controlled study to evaluate the effectiveness of risperidone (0.02 to 0.06 mg/kg/day) compared with placebo in the treatment of children 5 to 12 years of age with mild, moderate, or borderline mental retardation, and who display destructive behaviors. The study has two phases: a run-in phase of 1 week and a treatment phase of 6 weeks. Patients receive placebo to be taken orally once a day during the first week (run-in). On the basis of scores on the Nisonger Child Behavior Rating Form (N-CBRF) and the Vineland Adaptive Behavior Scale after the first week, patients either continue in the double-blind treatment phase or discontinue the study. During the treatment phase patients receive an oral solution of risperidone (increasing gradually to a maximum dose of 0.06 mg/kg) or placebo to be taken once daily for 6 weeks. A parent or caregiver evaluates the child’s behavior and symptoms at scheduled office visits during the course of treatment. The primary measure of effectiveness is the change in the Conduct Problem subscale of the Nisonger Child Behavior Rating Form (N-CBRF) at end of treatment compared with baseline. Additional assessments of effectiveness include: the Aberrant Behavior Checklist (ABC), the Behavioral Problems Inventory (BPI), and the Clinical Global Impression (CGI). Safety assessments include the incidence of adverse events throughout the study; weekly measurement of vital signs (pulse, temperature, blood pressure) and evaluation of the presence and severity of extrapyramidal symptoms by the Extrapyramidal Symptom Rating Scale (ESRS); and clinical laboratory tests performed both before study initiation and at the end of treatment. The study hypothesis is that risperidone is well tolerated and effective for the treatment of conduct disorder in children aged 5 to 12 years with mild, moderate, or borderline mental retardation. Risperidone oral solution 1 mg/mL or placebo oral solution, once daily on Days 1 and 2 at dose of 0.01 mg/kg body weight. Dose is 0.02 mg/kg on Day 3, increasing gradually to 0.06 mg/kg (maximum) once daily through 6 weeks. Dosage may be increased or decreased at investigator’s discretion.}

Here’s the best I can do with that. In the early days, they planned to market Risperdal as a safe way to medicate retarded, autistic, etc. kids for behavior control. There were even guidelines etc. developed [Google Dr. Aman for details]. That indication apparently didn’t fly, so they shifted gears and tried to call the disruptive behavior comorbid bipolar disorder, and revived their old data with a new set of authors, the bipolar child gurus at Harvard. That’s perhaps the reason there are so many bipolar comorbidities – ADHD, DBD, CD, Autism, etc. This is just a hunch based on all the odd comorbidity papers in the bipolar literature and the retooling of old data [in 1998 when the study was done, there was no "bipolar child"].