Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY). Part I: A review

Sarah B. Schur, Lin Sikich, Robert L. Findling, Richard P. Malone, M. Lynn Crismon, Albert Derivan, James C. MacIntyre, Elizabeth Pappadopulos, Laurence Greenhill, Nina Schooler, Kimberly Van Orden, Peter S. Jensen

Research output: Contribution to journalArticlepeer-review

139 Scopus citations


Objectives: To review the evidence for the safety and efficacy of nonpharmacological and pharmacological treatments for aggression in children and adolescents. Method: Medline and PsycINFO searches (1990-present) were conducted for double-blind, placebo-controlled studies of atypical antipsychotics for aggression and for literature on the use of other pharmacological agents and psychosocial interventions for aggression. Case reports and adult literature regarding the safety of atypical antipsychotics were used where controlled data for youth were lacking. Results: Controlled data on the treatment of aggression in youth is scarce. Psychosocial interventions may be effective alone or in combination with pharmacological treatments. Psychotropic agents (e.g., stimulants, mood stabilizers, β-blockers) have also been shown to have limited efficacy in reducing aggression. Antipsychotics, particularly the atypical antipsychotics, show substantial efficacy in the treatment of aggression in selected pediatric populations. Atypical antipsychotics are generally associated with fewer extrapyramidal symptoms than are typical antipsychotics. Conclusions: Psychosocial interventions and atypical antipsychotics are promising treatments for aggression in youth. Double-blind studies should examine the safety and efficacy of atypical antipsychotics compared to each other and to medications from other classes, the efficacy of specific medications for different subtypes of aggression, combining various psychotropic medications, optimal dosages, and long-term safety.

Original languageEnglish (US)
Pages (from-to)132-144
Number of pages13
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number2
StatePublished - Feb 2003
Externally publishedYes


  • Aggression
  • Antipsychotics
  • Psychosocial treatments

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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