title: 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 2: antipsychotics and traditional mood stabilizers.
abstract: OBJECTIVE
  Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes.
  
  
  METHODS
  We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach.
  
  
  RESULTS
  Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD.
  
  
  CONCLUSIONS
  With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality.
authors.affiliation: Assistant Professor, Department of Clinical Neurosciences, Psychiatry, Community Health Sciences, and Pediatrics, University of Calgary, Calgary, Alberta; Neurologist, Director, Calgary Tourette and Paediatric Movement Disorders Clinic, Calgary, Alberta.
authors.forename: Tamara
authors.initials: T
authors.lastname: Pringsheim
authors.affiliation: Student, Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hirsch
authors.affiliation: Professor, Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, Nova Scotia.
authors.forename: David
authors.initials: D
authors.lastname: Gardner
authors.affiliation: Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Gorman
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000187:drug effects*; D000927:Anticonvulsants / Q000494:pharmacology*; D018692:Antimanic Agents / Q000494:pharmacology*; D014150:Antipsychotic Agents / Q000494:pharmacology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy*; D002648:Child; D019955:Conduct Disorder / Q000188:drug therapy*; D006801:Humans
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents