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Systematic review of pharmacotherapy of disruptive behavior disorders in children and adolescents

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Abstract

Rationale

Pharmacotherapy is frequently considered in the treatment of disruptive behavior disorders (DBDs) in children and adolescents. There are, however, no systematic reviews of this literature.

Objectives

The aim of this work is to determine whether medication is effective in treating pediatric disruptive behavior disorders and related problems of impulse control, as well as to examine differences in the treatment response and tolerability of different medication classes and agents.

Materials and methods

Randomized controlled trials of the pharmacotherapy of DBDs in children and adolescents were reviewed, and a meta-analysis of 14 trials (823 participants) was conducted.

Results

There is some evidence of the effectiveness of medication in treating DBDs, with positive outcomes for lithium and risperidone in particular. Pharmacotherapy also demonstrated some efficacy in reducing symptoms of aggression. Medication was relatively well-tolerated, as indicated by equivalent dropout rates in medication and comparison groups.

Conclusions

There are relatively few controlled trials of the pharmacotherapy of disruptive behavior disorders or other impulse control disorders, despite the importance of research in this area. Given the potential adverse effects of agents such as lithium and risperidone, a careful risk–benefit analysis is needed for each patient.

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Notes

  1. A consensus statement sponsored by Johnson & Johnson, the manufacturers of risperidone.

  2. See Aman et al. (2004) for evidence that combined risperidone/stimulant treatment may be more effective than stimulant monotherapy for DBDs in children with subaverage IQs.

Abbreviations

ADHD:

attention deficit/hyperactivity disorder

CD:

conduct disorder

DBD:

disruptive behavior disorders

DSM:

Diagnostic and Statistical Manual

ICD-10:

International Classification of Diseases (10th edition)

ODD:

oppositional defiant disorder

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Acknowledgements

Dan Stein has received research grants and/or consultancy honoraria from Astrazeneca, Eli-Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth. He has participated in a number of ongoing trials and has presented data from some of these trials on behalf of the sponsoring companies.

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  1. MRC Anxiety and Stress Disorders Research Unit, Psychiatry Department, University of Stellenbosch, Stellenbosch, South Africa

    Jonathan Ipser

  2. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Dan J. Stein

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Correspondence to Jonathan Ipser.

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Ipser, J., Stein, D.J. Systematic review of pharmacotherapy of disruptive behavior disorders in children and adolescents. Psychopharmacology 191, 127–140 (2007). https://doi.org/10.1007/s00213-006-0537-6

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