Blader 2010.

Methods	A non‐randomised trial with no placebo group of methylphenidate use and the factors associated with aggression that is responsive versus refractory to individualised optimisation of stimulant monotherapy
Participants	Number of participants screened: 304 Number of participants included: 68 Number of participants followed up: 65 Number of withdrawals: 3 Diagnosis of ADHD: not stated (subtype: not stated) Age: mean: 8.95, range: 6‐13 years old IQ: > 70 Sex: 50 males, 15 females Methylphenidate‐naïve: none Ethnicity: white: 72%, African American: 12%, Hispanic: 8%, others: 8% Country: USA Setting: outpatient clinic Comorbidity: ODD: 94%; CD: 6%; anxiety disorder: 29%; depressive disorder: 65% Comedication: not stated Sociodemographics: not stated Inclusion criteria Aged between 6 and 13 Fulfill diagnostic criteria for ADHD Fulfill criteria for ODD or CD Obtain parent reported ratings of clinically significant aggression (R‐MOAS) Previous stimulant treatment at a minimum of methylphenidate dosage 30 mg/day or equivalent with insufficient response Exclusion criteria Major depression, bipolar disorder, Tourette syndrome, psychotic disorders, pervasive developmental disorder, mental retardation and aggressive behaviour arising chiefly as a complication of an anxiety disorder Contraindications to stimulant treatment Seizure disorders Pregnancy
Interventions	Methylphenidate type: triphasic‐release methylphenidate Methylphenidate dosage: 64 mg (refractory) and 52 mg (non‐refractory) Administration schedule: weekly dosage adjustments from 18 mg of normally 18 mg increments to reach best tolerated dosage associated with greatest overall improvement in ADHD symptoms and aggression to a maximum dosage of 90 mg/day; once daily after waking but no later than 8.30 am Duration of intervention: average 63.26 days (SD 23.98) Treatment compliance: 3 withdrawals due to low adherence
Outcomes	Non‐serious adverse events: Weight, observer, weekly Height, observer, weekly Blood pressure, observer, weekly Heart rate, observer, weekly Barkley Behaviour and Adverse Events Questionnaire Modified, parent, weekly A BBAEQ‐M item was considered present when the parent rated it at least moderate
Notes	Sample calculation: no Ethics approval: no, approved by institutional review boards of 2 clinical sites Funding/vested interests: National Institutes of Health Grants K23MH064975 and M01RR10710, a Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression and a grant for investigator‐initiated research from Abbot Laboratories Authors' affiliations:all authors have received research support in the past from pharmaceutical companies and/or consulting and/or speaking fees. Key conclusions of the study authors: among children whose aggressive behaviour develops in the context of ADHD and of oppositional defiant disorder or conduct disorder, and who had insufficient response to previous stimulant treatment in routine clinical care, systematic, well‐monitored titration of stimulant monotherapy often culminates in reduced aggression that averts the need for additional agents Exclusion of methylphenidate non‐responders/children who have previously experienced adverse events on methylphenidate: yes, according to exclusion criteria no. 2