Treatment of Severe Childhood Aggression (The TOSCA Study)

Inclusion Criteria: * DSM-IV diagnosis of ADHD, any subtype * DSM-IV diagnosis of a disruptive behavior disorder, including CD or ODD * Evidence of serious physical aggression, as rated on the Overt Aggression Scale-Modified, and as determined by parent or guardian ratings on the NCBRF D-Total Score. In addition, the blinded clinician must assign a clinical global impressions severity score of 4 or greater for aggression. * Prior to random assignment, participants must be free of all psychotropic medicines for 2 weeks for most drugs (such as most antidepressants, alpha agonists, beta blockers, anxiolytics, mood stabilizers, and antihistamines), and 4 weeks for depot antipsychotics and fluoxetine. Exclusion Criteria: * Full-scale IQ below 71 * Pregnancy or a history of seizure disorder or other neurological or medical disorders for which medication may present a considerable risk * Abnormal liver function * Pervasive developmental disorder, schizophrenia or other psychotic disorders, or eating disorders * Currently taking other psychotropic medications from which discontinuation would present a significant risk. Participants may not discontinue a satisfactory medication to participate. * Presence or history of major depressive disorder * Diagnosis of bipolar disorder * A hypomanic/biphasic score of 36 or greater as rated by child's parent on the General Behavior Inventory and confirmed by clinician as indication of mood disorder * Active substance abuse disorder or lack of …