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 1: psychostimulants, alpha-2 agonists, and atomoxetine.
abstract: OBJECTIVE
  Children with attention-deficit hyperactivity disorder (ADHD) may have oppositional behaviour, conduct problems, and aggression. These symptoms vary in severity, and may be related to a comorbid diagnosis of oppositional defiant disorder (ODD) or conduct disorder (CD). Critical evaluation of the efficacy of ADHD medications may guide the clinician regarding the usefulness of medications for these symptoms.
  
  
  METHODS
  We performed a systematic review and meta-analysis of psychostimulants, alpha-2 agonists, and atomoxetine for oppositional behaviour, conduct problems, and aggression in youth with ADHD, ODD, and CD. The quality of evidence for medications was rated using the Grading of Recommendations Assessment, Development and Evaluation approach.
  
  
  RESULTS
  Two systematic reviews and 20 randomized controlled trials were included. There is high-quality evidence that psychostimulants have a moderate-to-large effect on oppositional behaviour, conduct problems, and aggression in youth with ADHD, with and without ODD or CD. There is very-low-quality evidence that clonidine has a small effect on oppositional behaviour and conduct problems in youth with ADHD, with and without ODD or CD. There is moderate-quality evidence that guanfacine has a small-to-moderate effect on oppositional behaviour in youth with ADHD, with and without ODD. There is high-quality evidence that atomoxetine has a small effect on oppositional behaviour in youth with ADHD, with and without ODD or CD.
  
  
  CONCLUSIONS
  Evidence indicates that psychostimulants, alpha-2 agonists, and atomoxetine can be beneficial for disruptive and aggressive behaviours in addition to core ADHD symptoms; however, psychostimulants generally provide the most benefit.
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; D018759:Adrenergic Uptake Inhibitors / Q000494:pharmacology*; D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology*; D000374:Aggression / Q000187:drug effects*; D000069445:Atomoxetine Hydrochloride / Q000494:pharmacology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000494:pharmacology*; D002648:Child; D019955:Conduct Disorder / Q000188:drug therapy*; D006801:Humans
chemical_list: D018759:Adrenergic Uptake Inhibitors; D058647:Adrenergic alpha-2 Receptor Agonists; D000697:Central Nervous System Stimulants; D000069445:Atomoxetine Hydrochloride