The effects of risperidone augmentation for treatment-resistant aggression in children with ADHD were evaluated in a placebo-controlled pilot study at the University of Miami Miller School of Medicine, FL. The mean risperidone dose at endpoint was 1.08 mg/day. Of 25 subjects entered in the study, 15 were receiving methylphenidate and 10 were receiving mixed salts amphetamine. After addition of risperidone, 100% improved by more than 30 points on the Children’s Aggression Scale-Parent total score (CAS-P) from baseline to week 4, whereas only 77% of the placebo group reported a similar response (P<0.05). No differences were reported on the CAS-Teacher total sore. No patient discontinued treatment because of adverse events. Abdominal pain occurred in 25% of risperidone group and 7.7% of placebo group. 
COMMENT. Risperidone may be an effective add-on therapy for stimulant resistant aggression in children with ADHD. Personally, I refer patients with significant aggressive symptoms to my colleagues in psychiatry or psychology. For neurologists and pediatricians who also treat psychiatric comorbidities in their ADHD patients, this article should be of interest. Aggression may be precipitated or exacerbated by stimulant medication in some ADHD patients.
The importance of adjunctive behavior treatment, coordinated between home and school, is stressed in a discussion of the pharmacotherapy of aggression with ADHD.