DISRUPTIVE CHILD X RX

Summary of findings: pharmacotherapy, compared with placebo, for oppositional behaviour, adolescents with ADHD, ODD, or CD14,15

Medication	Population	Outcome	Placebo-controlled trials, n	Total number of participants, n	Effect size or OR (95% CI)	Quality of evidence
Psychostimulants	Children and adolescents with ADHD, with or without ODD or CD	Oppositional behaviour, conduct problems, and aggression	40	2364	Studies from 1970 to 200126:	High
					Cohen d:
					Clinician: 0.77 (0.63 to 0.88)
					Parent: 0.71 (0.42 to 1.15)
					Teacher: 1.04 (0.79 to 1.32)
					Studies from 2002 to 2013:
					SMD:
					Parent: 0.55 (0.36 to 0.73)
					Teacher: 0.84 (0.59 to 1.10)
Atomoxetine	Children and adolescents with ADHD, with or without ODD or CD	Oppositional behaviour	15	1907	SMD 0.33, (0.24 to 0.43)	High
Guanfacine	Children and adolescents with ADHD, with or without ODD	Oppositional behaviour	2	678	SMD 0.43 (0.18 to 0.68)	Moderate
Clonidine	Children and adolescents with ADHD, with or without ODD or CD	Oppositional behaviour and conduct problems	6	545	SMD 0.27 (0.04 to 0.51)	Very low
Risperidone	Children and adolescents with average IQ and ODD or CD, with or without ADHD	Disruptive and aggressive behaviour	4a	429	SMD 0.60 (0.31 to 0.89)	High
Risperidone	Children and adolescents with low IQ and ODD or CD, with or without ADHD	Conduct problems and aggression	5a	398	SMD 0.72 (0.47 to 0.97)	Moderate
Quetiapine	Adolescents with CD, with or without ADHD	Conduct problems	1	19	SMD 1.6 (0.9 to 3.0)	Very low
Haloperidol	Children with CD	Aggression	1	61	Magnitude of effect was not reported, but a significant difference from placebo was found on some measures	Very low
Valproate	Children and adolescents with ODD or CD, with or without ADHD	Aggression	2	50	OR 14.60 (3.25 to 65.61) for response	Low
Lithium	Children and adolescents with CD	Aggression	4	184	OR 4.56 (1.97 to 10.56) for response or remission	Low
Carbamazepine	Children with CD	Aggression	1	24	No significant difference	Very low