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The impact of psychiatrists’ views on the pharmacological management of Aggression, Violence, Agitation and Irritability when prescribing for children and young people, with or without an intellectual disability.

Lookup NU author(s): Dr Boroka Balazs-Becsi, Dr Marc Woodbury-Smith, Dr Iain McKinnonORCiD

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Abstract

Background: There is a paucity of guidance on the clinical management of aggression, violence, agitation, and irritability (AVAI) in children and young people. The evidence becomes more restricted when the young person has an intellectual disability. The use of psychotropic medication in managing AVAI is a challenging area for all involved, but the approach and rational for considering medication has a small evidence base to support it. Consequently, this study explored the prescribing characteristics, beliefs and attitudes of psychiatrists who work with young people presenting with AVAI. Methods: Semi-structured interviews were conducted with ten experienced consultant psychiatrists who work with young people under 18 years of age in the UK NHS setting. Participants were purposively recruited from two mental health trusts in the North-East of England. Data were analysed using a framework method derived from Thematic Analysis. Results: Data analysis resulted in the generation of 1168 primary codes, which were organized into categories due to similarity of ideas. Six interlinked themes were derived from the categories: purpose of AVAI, nature of request, impact of medication, clinician factors, knowledge base and baseline threshold for prescribing. The framework demonstrated that these six themes guide a psychiatrist’s decision to prescribe. Discussion: The study’s findings show the complex thought processes involved in managing AVAI in children and young people. The shared themes amongst psychiatrists that emerged from this analysis illustrates the role medication plays within holistic approaches to managing AVAI and introduces the concept of “prescribing threshold” at the centre of medication decision making.

Publication metadata

Author(s): Thompson J, Balazs-Becsi B, Woodbury-Smith M, McKinnon I

Publication type: Article

Publication status: In Press

Journal: Emotional and Behavioural Difficulties

Year: 2026

Acceptance date: 06/02/2026

ISSN (print): 1363-2752

ISSN (electronic): 1741-2692

Publisher: Routledge

Notes: Violence, Aggression, Young people, Intellectual disability, Pharmacology

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