Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder. The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. A Pilot Study of Methyiphenidate, Clonidine, or the Combination in ADHD Comorbid with Aggressive Oppositional Defiant or Conduct Disorder Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder Effect of atomoxetine on quality of life and family burden: results from a randomized, placebo-controlled, double-blind study in children and adolescents with ADHD and comorbid oppositional defiant or conduct disorder Stimulant-Responsive and Stimulant-Refractory Aggressive Behavior Among Children With ADHD Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA) Combining Parent and Child Training for Young Children with ADHD Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A Randomized-Controlled Clinical Trial An efficacy study of a combined parent and teacher management training programme for children with ADHD Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. Parent and Teacher SNAP-IV Ratings of Attention Deficit Hyperactivity Disorder Symptoms A randomized controlled trial of pemoline for attention-deficit/hyperactivity disorder in substance-abusing adolescents.
INTRODUCTION Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylpheni date preparation ( Medikinet retard , MPH-MR ) , with equal portions of the immediate-release and the sustained-release active substance , and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology . METHODS Eighty five children and adolescents ( 6 - 16 years ) were investigated in a double-blind , r and omized , clinical trial over 5 weeks under a treatment with MPH-MR  using symptom checklists for ADHD , oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) . RESULTS A total of 64.9 % of the children showed oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms . A statistically significant effect was found in the group treated with MPH ( verum-group ) . On the basis of Cohen 's criteria , high effects were found for aggressive symptoms in school ( d = 1.0 ) , but not in the afternoon ( d = 0.4 ) . There were also lower effect sizes for more severe aggressive symptoms . We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention . CONCLUSIONS Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior , especially concerning milder symptoms . The expected correlation between impulsivity and aggressiveness could be confirmed OBJECTIVE To assess the effect of methylpheni date on the diagnosis of oppositional-defiant disorder ( ODD ) comorbid with attention-deficit hyperactivity disorder ( ADHD ) . METHOD We conducted an open-label study in which 10 children and adolescents with a dual diagnosis of ODD and ADHD were assessed for their ODD symptoms and treated with methylpheni date . At least one month after ADHD symptoms were under control , ODD symptoms were reevaluated with the Parent form of the Children Interview for Psychiatric Syndromes ( P-ChIPS ) . RESULTS Nine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylpheni date for ADHD . CONCLUSION Methylpheni date seems to be an effective treatment for ODD , as well as for ADHD itself . The implication s for the treatment of patients with ODD not comorbid with ADHD needs further investigation A pilot comparison of the safety and efficacy of methylpheni date ( MPH ) combined with clonidine , clonidine monotherapy , or MPH monotherapy in 6to 16-year-old children diagnosed with attention deficit hyperactivity disorder ( ADHD ) and comorbid aggressive oppositional defiant disorder or conduct disorder was completed . Study design was a 3-month , r and omized , blinded , group comparison with eight subjects per group . No placebo comparison was used . All three treatment groups showed significant improvements in attention deficits , impulsivity , oppositional , and conduct disordered symptoms as assessed by parent and teacher rating scales and laboratory measures . Significant differences among treatment groups were found only on a few measures . Only the clonidine monotherapy group showed significantly decreased fine motor speed . These results suggest the safety and efficacy of clonidine alone or in combination with MPH for the treatment of ADHD and aggressive oppositional and conduct disorders OBJECTIVE To examine ( 1 ) moderating effects of oppositional defiant disorder ( ODD ) on attention-deficit/hyperactivity disorder ( ADHD ) treatment response and ( 2 ) responses of ODD symptoms to atomoxetine . METHOD Children and adolescents ( ages 8 - 18 ) with ADHD were treated for approximately 8 weeks with placebo or atomoxetine ( fixed dosing : 0.5 , 1.2 , or 1.8 mg/kg/day , b.i.d . ) under r and omized , double-blind conditions . Among patients with lifetime diagnostic information ( n = 293 ) , 39 % were diagnosed with comorbid ODD and 61 % were not . Treatment-group differences and differences between patients with and without comorbid ODD were examined post hoc for changes on the Attention-Deficit/Hyperactivity Disorder Rating Scale IV-Parent version , investigator-administered and -scored ; Conners ' Parent Rating Scale-Revised Short Form ; Clinical Global Impressions Severity of ADHD Scale ; and the parent-rated Child Health Question naire . RESULTS Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD , ODD , and quality -of-life measures . Treatment response was similar in youths with and without ODD , except that the comorbid group showed improvement compared with placebo at 1.8 mg/kg/day but not 1.2 mg/kg/day . In contrast , youths without ODD showed improvement at 1.2 mg/kg/day and no incremental benefit at 1.8 mg/kg/day . CONCLUSIONS Atomoxetine treatment improves ADHD and ODD symptoms in youths with ADHD and ODD , although the comorbid group may require higher doses Children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ; n = 142 ) were prospect ively monitored into adolescence ( 13 - 18 years old ) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD ( n = 100 ) . Prob and s reported higher levels of alcohol , tobacco , and illicit drug use than did controls . Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses . Within prob and s , severity of childhood inattention symptoms predicted multiple substance use outcomes : childhood oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms predicted illicit drug use and CD symptoms . Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls . Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted OBJECTIVES This study examines the tolerability and efficacy of methylpheni date ( MPH ) and behavior modification therapy ( BMOD ) in children with attention-deficity/hyperactivity disorder ( ADHD ) and severe mood dysregulation ( SMD ) . METHODS Children ( ages 5 - 12 ) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessment s and direct clinical interview with the Young Mania Rating Scale ( YMRS ) . The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores ( mean = 23.7 ) . They underwent weekly mood assessment s plus the daily ADHD measures that are part of the program . The comparison group ( n = 68 ) was comprised of the rest of the program participants . Using a crossover design , all subjects in both groups were treated with three varying intensities of BMOD ( no , low , high ) each lasting 3 weeks , with MPH dose ( placebo , 0.15 mg/kg t.i.d . , 0.3mg/kg t.i.d . , and 0.6 mg/kg t.i.d . ) varying daily within each behavioral treatment . RESULTS Groups had comparable ADHD symptoms at baseline , with the SMD group manifesting more oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms ( p < 0.001 ) . Both groups showed robust improvement in externalizing symptoms ( p < 0.001 ) . There was no evidence of differential treatment efficacy or tolerability . Treatment produced a 34 % reduction in YMRS ratings in SMD subjects ( p - 0.001 ) . However , they still exhibited elevated YMRS ratings , more ODD/CD symptoms ( p < 0.001 ) , and were more likely to remain significantly impaired at home than non-SMD subjects ( p < 0.05 ) . CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD , but additional treatments may be needed to optimize their functioning Children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems . This study provides an initial examination of the 1-year prospect i ve association between sleep problems and comorbid symptoms in youth diagnosed with ADHD . Participants were 81 young adolescents ( 75 % male ) carefully diagnosed with ADHD and their parents . Parents completed measures of their child ’s sleep problems and ADHD symptoms , oppositional defiant disorder ( ODD ) symptoms ,  and general externalizing behavior problems  at baseline ( Mage = 12.2 ) and  externalizing behaviors were assessed again 1 year later . Adolescents completed measures of anxiety and depression at both time-points . Medication use was not associated with sleep problems or comorbid psychopathology symptoms . Regression analyses indicated that , above and beyond demographic characteristics , ADHD symptom severity , and initial levels of comorbidity , sleep problems significantly predicted greater ODD symptoms , general externalizing behavior problems , and depressive symptoms 1 year later . Sleep problems were not concurrently or prospect ively associated with anxiety . Although this study precludes making causal inferences , it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD . Additional research is needed with larger sample s and multiple time-points to further examine the interrelations of sleep problems and comorbidity Purpose To evaluate the effect of atomoxetine on quality of life ( QoL ) and family burden in children and adolescents with attention deficit/hyperactivity disorder ( ADHD ) and comorbid oppositional defiant ( ODD ) or conduct disorder ( CD ) . Methods This secondary analysis was based on a r and omized , double-blind , 9-week study of atomoxetine ( target dose 1.2 mg/kg body weight ) versus placebo . The study included 180 patients ( atomoxetine 121 , placebo 59 ) , aged 6–17 years .  QoL was measured using the KINDL-R question naire . The total score encompasses six dimensions ( or subscales ) measuring QoL in terms of “ physical well-being ” , “ emotional well-being ” , “ self-esteem ” , “ friends ” , “ family ” , and “ school ” . Family burden of illness was measured using the FaBel question naire . Results With atomoxetine , the KINDL-R total score improved significantly ( P = 0.021 ) more than with placebo . This improvement also applied to the subscales except for “ physical well-being ” ( opposite effect ) and “ school ” ( no effect ) . No significant treatment group differences were seen on the FaBel question naire . No differences were found between the fast and slow titration groups in terms of ADHD , ODD , and disruptive behavior severity . Furthermore , no such differences were observed for QoL and family burden . Conclusions This study suggests positive effects of atomoxetine on quality of life , as measured by the KINDL-R scores on emotional well-being , self-esteem , friends and family , in children and adolescents with ADHD and comorbid ODD/CD . No significant treatment effects were seen on family burden , as measured by FaBel total score OBJECTIVES : The objective of this study was to examine factors that are associated with aggression that is responsive versus refractory to individualized optimization of stimulant monotherapy among children with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS : Children who were aged 6 to 13 years and had ADHD , either oppositional defiant disorder or conduct disorder , significant aggressive behavior , and a history of insufficient response to stimulants completed an open stimulant monotherapy optimization protocol  . Stimulant titration with weekly assessment s of behavior and tolerability identified an optimal regimen for each child . Families also received behavioral therapy . Parents completed the Retrospective-Modified Overt Aggression Scale ( R-MOAS ) at each visit . Children were classified as having stimulant-refractory aggression on the basis of R-MOAS ratings and clinician judgment . Differences that pertained to treatment , demographic , and psychopathology between groups with stimulant monotherapy – responsive and –refractory aggression were evaluated . RESULTS : Aggression among 32 ( 49.3 % ) of 65 children was reduced sufficiently after stimulant dosage adjustment and behavioral therapy to preclude adjunctive medication . Those who responded to stimulant monotherapy were more likely to benefit from the protocol 's methylpheni date preparation ( once-daily , triphasic release ) , showed a trend for lower average dosages , and received fewer  behavioral therapy  sessions than did children with stimulant-refractory aggression . Boys , especially those with higher ratings of baseline aggression and of depressive and manic symptoms , more often exhibited stimulant-refractory aggression . CONCLUSIONS : Among children whose aggressive behavior 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 Objective Clinical ly impairing irritability affects 25 % to 45 % of children with attention-deficit/hyperactivity disorder ( ADHD ) ; yet , we know little about what interventions are effective in treating children with ADHD and co-occurring irritability . We used data from the Multimodal Treatment Study of Children With ADHD ( MTA ) to address 3 aims : to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder ( ODD ) ; to examine whether ADHD treatment is effective in treating irritability ; and to examine how irritability influences ADHD treatment outcomes . Method Secondary analyses of data from the MTA included multivariate analyses , and intent-to-treat r and om-effects regression models were used . Results Irritability was separable from other ODD symptoms . For treating irritability , systematic stimulant treatment was superior to behavioral management but not to routine community care ; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone , but not to medication alone . Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups . Conclusion Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD . Moreover , irritability does not appear to influence the response to treatment of ADHD . Clinical trial registration information Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http://www . clinical trials.gov ; NCT00000388 The efficacy of the Incredible Years parent and child training programs is established in children diagnosed with oppositional defiant disorder but not among young children whose primary diagnosis is attention-deficit/hyperactivity disorder ( ADHD ) . We conducted a r and omized control trial evaluating the combined parent and child program interventions among 99 children diagnosed with ADHD ( ages 4–6 ) . Mother reported significant treatment effects for appropriate and harsh discipline , use of physical punishment , and monitoring , whereas fathers reported no significant parenting changes . Independent observations revealed treatment effects for mothers ' praise and coaching , mothers ' critical statements , and child total deviant behaviors . Both mothers and fathers reported treatment effects for children 's externalizing , hyperactivity , inattentive and oppositional behaviors , and emotion regulation and social competence . There were also significant treatment effects for children 's emotion vocabulary and problem-solving ability . At school teachers reported treatment effects for externalizing behaviors and peer observations indicated improvements in treated children 's social competence Evaluated efficacy of social skills training ( SST ) on children with 2 subtypes of attention deficit hyperactivity disorder ( ADHD ) . Participants were 120 children ( 30 girls , 90 boys ) , ages 8 to 12 with ADHD-Inattentive type ( ADHD-I ; n = 59 ) or Combined type ( ADHD-C ; n = 61 ) . The children were r and omly assigned within diagnosis subtype to the treatment condition ( 8 weeks of SST ) or the no-intervention control condition . SST led to greater improvements in both parent- and child-perceived assertion skills in the children with ADHD , yet did not affect the other domains of social competence . Diagnostically heterogeneous groups led to greater improvements on parent-report of their child 's cooperation and assertion abilities as well as children 's report of their own empathy skills . Diagnostically homogeneous groups led to greater decreases in externalizing behaviors at posttreatment but not at follow-up . Children with comorbid oppositional defiant disorder ( ODD ) did not benefit as much from the intervention . Children with ADHD-I improved in assertion skills more than children with ADHD-C , yet the 2 diagnostic entities did not differ in improvement levels across all other social skills Background : Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder ( ADHD ) and /or oppositional defiant disorder ( ODD ) during the last few decades . Group format has often been used for parent training but single-subject design s are more common in teacher training . More studies have focussed on pre-school children than on older children , and a minority have been conducted in public mental health setting s. Aim : This study aim ed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden . Method : The intervention was a modified version of Barkley 's programme .  Children were r and omized to an Intervention or a Control group .  Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms , and about behavioural problems when the study started and at a 3-month follow-up . Results : Results showed that the intervention result ed in a reduction of the number of children who met DSM-IV criteria for ADHD and /or ODD . Effects were more pronounced in the home setting than in the school setting , and were further accentuated when both parents and teachers of the same child took part in the intervention . Teachers with more problematic classroom situations benefited most from the intervention . Conclusion : The programme , “ Strategies in Everyday Life ” , has , in a regular clinical setting , demonstrated promising effects on children 's disruptive behaviour , and a clinical implication was to recommend involving both parents and teachers in the programme OBJECTIVE The aim of this study was to examine the safety and efficacy of risperidone , with or without concomitant psychostimulant use , in the treatment of children with conduct disorder ( CD ) or other disruptive behavior disorders [ oppositional defiant disorder ( ODD ) , disruptive behavior disorder-not otherwise specified ( DBD-NOS ) ] , and comorbid attention-deficit hyperactivity disorder ( ADHD ) . METHODS Data from two 6-week placebo-controlled trials assessing risperidone therapy in children with subaverage IQs and CD , ODD , DBD-NOS were combined , and patients with comorbid ADHD were selected for this post hoc analysis . Patients were grouped according to r and omized drug therapy ( risperidone or placebo ) , and then subgrouped according to their use of a concomitant psychostimulant .  Safety outcomes included adverse events and weight change , while efficacy outcomes included changes in scores on disruptive behavior and hyperactivity-based subscales of two behavior-rating instruments ( Nisonger Child Behavior Rating Form and the Aberrant Behavior Checklist ) . RESULTS The analysis included 155 of 208 originally tested children divided into four sub-groups ( 35 - 43 patients each ) . There was no significant difference in the frequency of adverse events in patients who received  risperidone  alone and those who received risperidone plus a stimulant . The most common adverse events in risperidone-treated patients were somnolence , headache , dyspepsia , rhinitis , and vomiting . Within each r and omized treatment group , actual weight gain was comparable , regardless of concomitant stimulant use . Risperidone-treated patients had clinical ly and statistically significant reductions in both disruptive behavior and hyperactivity subscale scores , compared to placebo , regardless of concomitant stimulant use . The addition of risperidone to a psychostimulant result ed in significantly better control of hyperactivity ( p < 0.001 ) than was achieved with stimulant treatment alone , without causing an increase in adverse events . CONCLUSION Risperidone was a safe and effective treatment , with or without a combined psychostimulant , for both disruptive behavior disorders and comorbid ADHD in children To examine Swanson , Nolan , and Pelham — IV ( SNAP-IV ) psychometric properties , parent ( N = 1,613 ) and teacher ( N = 1,205 ) data were collected from a r and om elementary school student sample in a longitudinal attention deficit hyperactivity disorder ( ADHD ) detection study . SNAP-IV reliability was acceptable . Factor structure indicated two ADHD factors and an oppositional defiant disorder ( ODD ) factor . Parent and teacher scores varied by gender and poverty status ( d = .49-.56 ) but not age ; only teacher scores varied by race ( d = .25-.55 ) . Screening and diagnostic utility was evaluated with likelihood ratios ( LRs ) and posttest probabilities . Parent SNAP-IV scores above 1.2 increased probability of concern ( LR > 10 ) and above 1.8 , of ADHD diagnosis ( LR > 3 ) . Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only ( LR = 4.2 and > 5 , respectively ) .  Higher teacher scores for African American children and race differences in measurement models require future study OBJECTIVE In adolescents with substance use disorder ( SUD ) , comorbid attention-deficit/hyperactivity disorder ( ADHD ) is associated with greater severity of substance abuse , conduct problems , and worse treatment outcomes . Although many controlled trials have established the efficacy of psychostimulants , including pemoline , for ADHD in children and adolescents , none have been conducted in adolescents with SUD . This r and omized , placebo-controlled trial , conducted between 1996 and 2000 , evaluated the safety and efficacy of pemoline on substance abuse and conduct problems . METHOD Sixty-nine adolescents ( aged 13 - 19 ) with conduct disorder ( CD ) , SUD , and ADHD were recruited from the community and r and omly assigned to a 12-week clinical trial of pemoline ( n = 35 ) or placebo ( n = 34 ) , titrated over 4 weeks to a single morning dose of 75 to 112.5 mg as tolerated . RESULTS Pemoline had greater efficacy than placebo for ADHD as determined by significantly more Clinician 's Global Impression-Improvement ( CGI-I ) ratings of 1 ( very much improved ) or 2 ( much improved ) at the study endpoint ( n = 69 ; p < .05 ) . There was also greater reduction in ADHD severity on the parent-rated Conners Hyperactivity-Impulsivity scale in pemoline-treated study completers compared to placebo-treated completers ( pemoline , n = 17 ; placebo , n = 16 ; p < .01 ) , but no difference between groups in the intent-to-treat analysis ( n = 68 ; p < .13 ) . Substance use did not decline in either group , and there was no difference between groups in baseline to study endpoint change in substance use or CD symptoms . Overall , pemoline was well tolerated , demonstrating a good safety profile and no elevation in liver enzyme levels . CONCLUSIONS Pemoline was efficacious for ADHD but did not have an impact on CD or substance abuse in the absence of specific treatment for SUD
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
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 .