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Can J Psychiatry. 2015 Feb;60(2):62-76.

Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder.

Author information

1
Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, The Hospital for Sick Children, Toronto, Ontario.
2
Professor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
3
Associate Professor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
4
Associate Professor, Department of Paediatrics, University of Toronto, Toronto, Ontario; Paediatrician, The Hospital for Sick Children and St Joseph's Health Centre, Toronto, Ontario.
5
Clinical Assistant Professor, Department of Paediatrics, Université de Montréal, Montreal, Quebec; Paediatrician (Diplôme d'études spécialisées Paediatric Neurology), Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec.
6
Professor, Departments of Psychiatry, Family Medicine, and Paediatrics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario.
7
Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
8
Lecturer, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, Youthdale Treatment Centres, Toronto, Ontario.
9
Clinical Assistant Professor, Department of Paediatrics, University of Calgary, Calgary, Alberta.
10
Child and Adolescent Psychiatrist, Glenrose Attention-Deficit Hyperactivity Disorder Clinic, Edmonton, Alberta.
11
Clinical Lecturer, Department of Psychiatry, University of Alberta, Edmonton, Alberta.
12
Assistant Professor, Department of Clinical Neurosciences, Psychiatry, Community Health Sciences, and Paediatrics, University of Calgary, Calgary, Alberta; Neurologist, Director, Calgary Tourette and Paediatric Movement Disorders Clinic, Calgary, Alberta.

Abstract

OBJECTIVE:

To develop evidence-based guidelines on pharmacotherapy for severe disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD). The guidelines assume that psychosocial interventions have been pursued but did not achieve sufficient improvement.

METHOD:

A multidisciplinary consensus group used the Grading of Recommendations Assessment, Development and Evaluation approach for rating evidence quality and for grading recommendations. We conducted a systematic review of medications studied in placebo-controlled trials for treating disruptive and aggressive behaviour in children and adolescents with ADHD, ODD, or CD. We followed consensus procedures to make 1 of 4 recommendations for each medication: strong, in favour (↑↑); conditional, in favour (↑?); conditional, against (↓?); and strong, against (↓↓).

RESULTS:

For children and adolescents with disruptive or aggressive behaviour associated with ADHD, psychostimulants received a strong recommendation in favour of use, while atomoxetine and alpha-2 agonists received a conditional recommendation in favour of use. If these patients do poorly with ADHD medications, the medication with the most evidence is risperidone. Risperidone also has the most evidence for treating disruptive or aggressive behaviour in the absence of ADHD. However, given risperidone's major adverse effects, it received only a conditional recommendation in favour of use. We recommended against using quetiapine, haloperidol, lithium, or carbamazepine because of the poor quality of evidence and their major adverse effects.

CONCLUSION:

When severe disruptive or aggressive behaviour occurs with ADHD, medications for ADHD should be used first. Other medications have major adverse effects and, with the exception of risperidone, very limited evidence to support their use.

PMID:
25886657
PMCID:
PMC4344948
DOI:
10.1177/070674371506000204
[Indexed for MEDLINE]
Free PMC Article

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