Treating pediatric aggressive behaviors and comorbid conditions.

Introduction: Aggressive behaviors in children and adolescents can significantly impair quality of life, leading to disruptions in both academic and social functioning. Despite decades of research, a standardized nosology for aggressive behaviors remains lacking, resulting in considerable variability in the design of treatment trials for aggression.

Areas covered: A comprehensive literature review was conducted to identify studies evaluating pharmacological treatments for aggressive behaviors in children and adolescents. Articles were sourced from multiple databases, focusing studies that investigated the use of medications for treating aggression, conduct problems, and disruptive behaviors.

Expert opinion: A significant barrier to effectively treating childhood aggression is the absence of a clear and standardized nosology. Aggression is frequently regarded as a symptom rather than a distinct clinical entity, complicating treatment decisions and hindering the ability to predict outcomes and develop targeted interventions. Notably, impulsive aggression has been the primary focus of research as a target for pharmacotherapy, highlighting the need to expand our understanding of aggression subtypes. A paradigm shift is necessary, emphasizing the development of operational definition of aggression diagnosis based on the type of aggressive behavior, the creation of screening tools, and the prediction of treatment outcomes to enhance both clinical practice and research.