Psychostimulants for aggression, and conduct problems in youth with CD with and without ADHD

Evidence Summaries for Current Care Guidelines
Eeva Aronen and Jorma Komulainen

Level of evidence: C

There is no trustworthy evidence, that psychostimulants would decrease aggression or conduct problems in children and adolescents with ODD or CD without comorbid ADHD.

In a study by Balia et al. (2017–18, in press) «Balia C, Carucci S, Coghill D ym. The pharmacologi...»1 the researchers systematically reviewed and, where data was adequate, conducted meta-analyses on the efficacy of medication on aggression in children and adolescent with CD considering the impact of CU traits. Five RCT-studies on psychostimulants were found to meet the study inclusion criteria investigating the efficacy of methylphenidate on aggression in CD.

Summary of the studies is shown in Table «Psychostimulants for aggression and conduct problems in youth with CD, with and without ADHD....»1.

Table 1. Psychostimulants for aggression and conduct problems in youth with CD, with and without ADHD.
Outcome Number of studies and patients Duration of studies Summary of findings
Aggression and conduct problems measured by rating scales 5 RCTs
242 patients
age 6–15 years
3 to 6 weeks Effect size (Cohen d), conduct prob
Parent -2.43, 95% CI -5.39 to 0.53
Teacher -2.62, 95% CI -4.67 to -0.57
SMD, aggression
Parent -2.94, 95% CI -6.06 to 0.18
Teacher -5.09, 95% CI -10.23 to 0.05

Two of these studies were conducted in subjects with a primary diagnosis of CD, but ADHD was not excluded and was a comorbidity in 69% of children in one study (n=83), the other study included 6 cases. The remaining three studies included a population of ADHD children and adolescent with comorbid CD in 55.5% and 68%, and a comorbid condition of ODD/CD in the 64% of cases. The results were not subanalyzed based on diagnostic groups.

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


  1. Balia C, Carucci S, Coghill D ym. The pharmacological treatment of aggression in children and adolescents with conduct disorder. Do callous-unemotional traits modulate the efficacy of medication? Neurosci Biobehav Rev 2018;91:218-238 «PMID: 28137460»PubMed