The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and atomoxetine.

Abstract

OBJECTIVE:

Children with attention-deficit hyperactivity disorder (ADHD) may have oppositional behaviour, conduct problems, and aggression. These symptoms vary in severity, and may be related to a comorbid diagnosis of oppositional defiant disorder (ODD) or conduct disorder (CD). Critical evaluation of the efficacy of ADHD medications may guide the clinician regarding the usefulness of medications for these symptoms.

METHOD:

We performed a systematic review and meta-analysis of psychostimulants, alpha-2 agonists, and atomoxetine for oppositional behaviour, conduct problems, and aggression in youth with ADHD, ODD, and CD. The quality of evidence for medications was rated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS:

Two systematic reviews and 20 randomized controlled trials were included. There is high-quality evidence that psychostimulants have a moderate-to-large effect on oppositional behaviour, conduct problems, and aggression in youth with ADHD, with and without ODD or CD. There is very-low-quality evidence that clonidine has a small effect on oppositional behaviour and conduct problems in youth with ADHD, with and without ODD or CD. There is moderate-quality evidence that guanfacine has a small-to-moderate effect on oppositional behaviour in youth with ADHD, with and without ODD. There is high-quality evidence that atomoxetine has a small effect on oppositional behaviour in youth with ADHD, with and without ODD or CD.

CONCLUSIONS:

Evidence indicates that psychostimulants, alpha-2 agonists, and atomoxetine can be beneficial for disruptive and aggressive behaviours in addition to core ADHD symptoms; however, psychostimulants generally provide the most benefit.

• Authors: Tamara Pringsheim, Lauren Hirsch, David Gardner, Daniel A Gorman
• Journal: Canadian journal of psychiatry. Revue canadienne de psychiatrie (Can J Psychiatry) Vol. 60 Issue 2 Pg. 42-51 (Feb 2015) ISSN: 1497-0015 [Electronic] United States
• PMID: 25886655 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Adrenergic Uptake Inhibitors
• Adrenergic alpha-2 Receptor Agonists
• Central Nervous System Stimulants
• Atomoxetine Hydrochloride

Topics

• Adolescent
• Adrenergic Uptake Inhibitors (pharmacology)
• Adrenergic alpha-2 Receptor Agonists (pharmacology)
• Aggression (drug effects)
• Atomoxetine Hydrochloride (pharmacology)
• Attention Deficit Disorder with Hyperactivity (drug therapy)
• Attention Deficit and Disruptive Behavior Disorders (drug therapy)
• Central Nervous System Stimulants (pharmacology)
• Child
• Conduct Disorder (drug therapy)
• Humans