Abstract | OBJECTIVE: 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.
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Authors | Daniel A Gorman, David M Gardner, Andrea L Murphy, Mark Feldman, Stacey A Bélanger, Margaret M Steele, Khrista Boylan, Kate Cochrane-Brink, Roxanne Goldade, Paul R Soper, Judy Ustina, Tamara Pringsheim |
Journal | Canadian journal of psychiatry. Revue canadienne de psychiatrie
(Can J Psychiatry)
Vol. 60
Issue 2
Pg. 62-76
(Feb 2015)
ISSN: 1497-0015 [Electronic] United States |
PMID | 25886657
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adolescent
- Aggression
(drug effects)
- Attention Deficit Disorder with Hyperactivity
(drug therapy)
- Attention Deficit and Disruptive Behavior Disorders
(drug therapy)
- Canada
- Child
- Conduct Disorder
(drug therapy)
- Humans
- Practice Guidelines as Topic
(standards)
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