Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management

Nancy Scotto Rosato, Christoph U. Correll, Elizabeth Pappadopulos, Alanna Chait, Stephen Crystal, Peter S. Jensen

Research output: Contribution to journalReview articlepeer-review

112 Scopus citations


OBJECTIVE: To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)e1577-e1586
Issue number6
StatePublished - Jun 2012

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health


  • Aggression
  • Behavior disorders problems
  • Guidelines
  • Psychosocial intervention
  • Psychotropic drugs


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