Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESPsychopharmacology and Aggression. I: A Meta-Analysis of Stimulant Effects on Overt/Covert Aggression–Related Behaviors in ADHD
Section snippets
METHOD
A literature search was completed to identify reports in which stimulants were used to treat aggression-related behaviors in youths with ADHD. Computerized searches were done with Medline and Pub Med for the years 1970 to 2001, reviewing both the medical and behavioral science literature. Key words included the following: aggression, violence, assault, CD, conduct problems, ODD, delinquency, antisocial behavior, overt aggression, covert aggression, stimulants, methylphenidate (MPH),
RESULTS
We identified 28 studies that met inclusion/exclusion criteria and included them in the meta-analysis. These 28 reports contributed 35 independent effect sizes to the meta-analysis, of which 28 described stimulant efficacy in treating overt aggression and 7 described stimulant effects on covert aggression.
Descriptive characteristics of the 28 studies appear in Table 1. The mean quality rating for these studies was 5.75 (range = 5–7), and study quality did not correlate significantly with
DISCUSSION
The main finding from this meta-analysis is that stimulants have significant treatment effects on aggression-related behaviors occurring in the context of ADHD separate from their effects on the core symptoms of ADHD. Averaging across all rater types, the overall weighted effect size is 0.84 for overt aggression and 0.69 for covert aggression. These effect sizes are defined as moderate to large (Cohen, 1988). The overall effect sizes for aggression-related behaviors in ADHD are of similar
REFERENCES (53)
- et al.
Clinical effects of methylphenidate and thioridazine in intellectually subaverage children
J Am Acad Child Adolesc Psychiatry
(1991) - et al.
Aggression in hyperactive boys: response to d-amphetamine
J Am Acad Child Psychiatry
(1984) - et al.
The adolescent outcome of hyperactive children diagnosed by research criteria, I: an 8-year prospective follow-up study
J Am Acad Child Adolesc Psychiatry
(1990) - et al.
The response of aggressive and nonaggressive ADHD children to two doses of methylphenidate
J Am Acad Child Adolesc Psychiatry
(1989)J Am Acad Child Adolesc Psychiatry
(1990) - et al.
Patterns of remission and symptom decline in conduct disorder: a four-year prospective study of an ADHD sample
J Am Acad Child Adolesc Psychiatry
(2001) - et al.
Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders
Am J Psychiatry
(1991) - et al.
Oppositional defiant disorder and conduct disorder: a meta-analytic review of factor analyses and cross-validation in a clinical sample
Clin Psychol Rev
(1993) - et al.
Methylphenidate in aggressive-hyperactive boys, I: effects on peer aggression in public school settings
J Am Acad Child Adolesc Psychiatry
(1990) - et al.
Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial
J Am Acad Child Adolesc Psychiatry
(2001) - et al.
Effects and noneffects of methylphenidate in children with mental retardation and ADHD
J Am Acad Child Adolesc Psychiatry
(1992)
On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology
Psychol Bull
Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder
Arch Gen Psychiatry
Empirical evidence for overt and covert patterns of antisocial conduct problems: a meta-analysis
J Abnorm Child Psychol
Drug treatment of hyperactivity in children
Dev Med Child Neurol
Comparative effects of methylphenidate on ADD girls and ADD boys
J Am Acad Child Adolesc Psychiatry
Meta-Analytic Procedures for Social Research
Which boys respond to stimulant medication? A controlled trial of methylphenidate in boys with disruptive behaviour
Psychol Med
Subtypes of aggression and their relevance to child psychiatry
J Am Acad Child Adolesc Psychiatry
Examination of DSM-IV criteria for attention-deficit/hyperactivity disorder
J Dev Behav Pediatr
Fenfluramine and methylphenidate in children with mental retardation and borderline IQ: clinical effects
Am J Ment Retard
Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)
Levoamphetamine vs dextroamphetamine in minimal brain dysfunction: replication, time response, and differential effect by diagnostic group and family rating
Arch Gen Psychiatry
Levoamphetamine and dextroamphetamine: comparative efficacy in the hyperkinetic syndrome. Assessment by target symptoms
Arch Gen Psychiatry
Attention-deficit hyperactivity disorder
Sci Am
Bupropion versus methylphenidate in the treatment of attention-deficit hyperactivity disorder
J Am Acad Child Adolesc Psychiatry
Pemoline treatment of adolescents with attention deficit hyperactivity disorder: a short-term controlled trial
J Child Adolesc Psychopharmacol
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The authors gratefully acknowledge Dr. Judith A. Hall for statistical assistance.