Conduct problem (CP) treatment guidelines espouse the initial use of psychosocial interventions before resorting to psychotropic medication (a concept referred throughout as the "least intrusive" principle). National prescription data shows a dramatic increase in the use of atypical antipsychotics to treat CP, raising concern that clinicians are disregarding the "least intrusive" principle, and using psychotropic medication as a first-line treatment for CP. Research has identified patient, clinician, organizational, and systemic factors that may be important to understanding this increased reliance on psychotropic medication in treating CP. The present study examines how a subset of these factors affect adherence to the "least intrusive" principle within a university-based outpatient psychiatry clinic. Data from 78 patient medical records (71% male; Mean age = 9.9 years) were analyzed using logistic regression to determine how patient race, gender, travel distance, aggression severity, internalizing severity, age of CP diagnosis, and history of psychosocial intervention for CP affected the likelihood that initial CP treatments included psychotropic medication. Results show that aggression severity and travel distance significantly increased the likelihood that initial treatments included psychotropic medication. Travel distance also significantly interacted with history of psychosocial intervention for CP to predict initial recommendations with psychotropic medication. Clinical implications and directions for future research are considered.
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