Takaisin

Psychostimulants for aggression, oppositional behaviour, and conduct disorders in youth with ADHD with and without ODD/CD

Evidence Summaries for Current Care Guidelines
Eeva Aronen and Jorma Komulainen
12.12.2018

Level of evidence: B

Treatment with psychostimulants seems to decrease aggression, oppositional behaviour, and conduct disorders in children and adolescents with ADHD with and without ODD/CD in the short term.

In the systematic review «Pringsheim T, Hirsch L, Gardner D ym. The pharmaco...»1 regarding 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, altogether 40 RCT studies with 2364 participants comparing psychostimulants with placebo were included. Summary of the studies is shown in Table «Psychostimulants for aggression, oppositional behaviour, and conduct problems in youth with ADHD, with and without ODD and CD....»1.

Table 1. Psychostimulants for aggression, oppositional behaviour, and conduct problems in youth with ADHD, with and without ODD and CD.
Outcome Number of studies and patients Duration of studies Summary of findings
Aggression,
oppositional behaviour,
conduct problems measured by rating scales
40 RCTs
2364 patients
2–16 weeks Studies 1970 to 2001
Effect size (Cohen d)
Clinician 0.77, 95 % CI 0.63 to 0.88
Parent 0.71, 95 % CI 0.42 to 1.15
Teacher 1.04, 95 % CI 0.79 to 1.32
Studies 2002 to 2013*
SMD
Parent 0.55, 95 % CI 0.36 to 0.73
Teacher 0.84, 95 % CI 0.59 to 1.10
*Based on 8 studies that provided adequate data on end point scores to be included in a meta-analysis

There were some limitations in the quality of included studies. No serious inconsistency, indirectness or imprecision was noticed. Publication bias was unlikely. Evidence of dose–response effect for this outcome was reported. Measures of aggression, oppositional behaviour, and conduct problems were included as a secondary outcome in all studies performed between 2002 and 2013. Most studies included children with ADHD alone, ADHD with ODD, or ADHD with CD, none of them subanalyzed results based on diagnostic groups. Nonetheless, the presence of comorbid ODD or CD (serious disruptive, aggressive symptoms) correlated negatively with effect size.

  • Study quality: High
  • Accessability: Good for Finnish patients
  • Comment: There was significant heterogeneity among the studies included in the quantitative analysis, and no sensitivity analysis was performed.

References

  1. Pringsheim T, Hirsch L, Gardner D ym. 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. Can J Psychiatry 2015;60:42-51 «PMID: 25886655»PubMed