Treatment of Maladaptive Aggression in Youth (T-MAY) Guidelines Toolkit

Psychotropic agents, particularly second-generation antipsychotics and mood stabilizers, are increasingly prescribed to youth on an outpatient basis for the treatment of overt aggression, a symptom that may have multiple causes. These large scale shifts in treatment practices have occurred despite potentially troubling side-effects and a lack of supportive empirical evidence. With the increase in the prescription of psychotropic agents outside of FDA-approved indications, concerns have been raised over treatment decision making, appropriate use of alternative therapies, long-term management, safety of multiple drug regimens, and successful parental engagement and education. Given its indistinct etiology and variability in frequency and severity of symptoms, as well as the presence of overlapping comorbidities, treating and managing aggression is generally difficult and complex.

To address this clinical need and improve outcomes for children and adolescents with maladaptive aggression, a steering committee was established to spearhead a consensus development and quality improvement initiative for clinicians treating such children and adolescents. Through the collaboration of the Resource for Advancing Children’s Health (REACH) Institute, the Center for Education and Research on Mental Health Therapeutics (CERTs) at Rutgers University, Columbia University/New York State Psychiatric Institute, and participating national experts in the fields of policy, research, advocacy and child and adolescent psychiatry, the Treatment of Maladaptive Aggression in Youth (T -MAY) guidelines were developed.

The T-MAY Toolkit, intended for both primary care and specialty mental health prescribers, is a concise reference guide designed to aid clinicians in their implementation of the T-MAY guideline. Successful implementation of the T-MAY guidelines ultimately relies on physician expertise and discretion. The T-MAY Toolkit is not intended to undermine or replace clinical judgment.



T-MAY Toolkit