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

Pediatrics. 2012 Jun;129(6):e1577-86. doi: 10.1542/peds.2010-1361. Epub 2012 May 28.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adolescent
  • Aggression / drug effects*
  • Aggression / psychology*
  • Consensus Development Conferences as Topic
  • Disease Management
  • Evidence-Based Medicine / standards*
  • Humans
  • Mental Disorders / diagnosis
  • Mental Disorders / drug therapy
  • Mental Disorders / psychology
  • Practice Guidelines as Topic / standards
  • Psychotherapy / methods
  • Psychotherapy / standards
  • Psychotropic Drugs / pharmacology
  • Psychotropic Drugs / therapeutic use
  • Social Support*
  • Treatment Outcome


  • Psychotropic Drugs