Table 2.
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 |
ADHD = attention-deficit hyperactivity disorder; CD = conduct disorder; ODD = oppositional defiant disorder; SMD = standardized mean difference
a
In 1 of these trials, 64% of subjects had an IQ of >84 and the remainder were in the 55-to-84 range37; thus this trial is included with the trials in subjects with average IQ, and with the trials in subjects with low IQ