Evidence map›Paper›PMID 25886657›Full record

ArticleCanadian journal of psychiatry. Revue canadienne de psychiatrie2015

Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder.

Daniel A Gorman, David M Gardner, Andrea L Murphy, Mark Feldman, Stacey A Bélanger, Margaret M Steele, Khrista Boylan, Kate Cochrane-Brink, Roxanne Goldade, Paul R Soper and 2 more

Abstract read
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In one paragraph

Article in Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Harms of Antipsychotics in Children and Young Adults: A Systematic Review Update.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2018
    Pooled it
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  13. Kylo Ren Was Redeemed: Star Wars Fans Rejoice and So Should Psychiatric Educators.Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Daniel A GormanAssistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, The Hospital for Sick Children, Toronto, Ontario.
David M GardnerProfessor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
Andrea L MurphyAssociate Professor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
Mark FeldmanAssociate Professor, Department of Paediatrics, University of Toronto, Toronto, Ontario; Paediatrician, The Hospital for Sick Children and St Joseph's Health Centre, Toronto, Ontario.
Stacey A BélangerClinical Assistant Professor, Department of Paediatrics, Université de Montréal, Montreal, Quebec; Paediatrician (Diplôme d'études spécialisées Paediatric Neurology), Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec.
Margaret M SteeleProfessor, Departments of Psychiatry, Family Medicine, and Paediatrics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario.
Khrista BoylanAssistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
Kate Cochrane-BrinkLecturer, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, Youthdale Treatment Centres, Toronto, Ontario.
Roxanne GoldadeClinical Assistant Professor, Department of Paediatrics, University of Calgary, Calgary, Alberta.
Paul R SoperChild and Adolescent Psychiatrist, Glenrose Attention-Deficit Hyperactivity Disorder Clinic, Edmonton, Alberta.
Judy UstinaClinical Lecturer, Department of Psychiatry, University of Alberta, Edmonton, Alberta.
Tamara PringsheimAssistant Professor, Department of Clinical Neurosciences, Psychiatry, Community Health Sciences, and Paediatrics, University of Calgary, Calgary, Alberta; Neurologist, Director, Calgary Tourette and Paediatric Movement Disorders Clinic, Calgary, Alberta.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo develop evidence-based guidelines on pharmacotherapy for severe disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD). The guidelines assume that psychosocial interventions have been pursued but did not achieve sufficient improvement.

methodA multidisciplinary consensus group used the Grading of Recommendations Assessment, Development and Evaluation approach for rating evidence quality and for grading recommendations. We conducted a systematic review of medications studied in placebo-controlled trials for treating disruptive and aggressive behaviour in children and adolescents with ADHD, ODD, or CD. We followed consensus procedures to make 1 of 4 recommendations for each medication: strong, in favour (↑↑); conditional, in favour (↑?); conditional, against (↓?); and strong, against (↓↓).

resultsFor children and adolescents with disruptive or aggressive behaviour associated with ADHD, psychostimulants received a strong recommendation in favour of use, while atomoxetine and alpha-2 agonists received a conditional recommendation in favour of use. If these patients do poorly with ADHD medications, the medication with the most evidence is risperidone. Risperidone also has the most evidence for treating disruptive or aggressive behaviour in the absence of ADHD. However, given risperidone's major adverse effects, it received only a conditional recommendation in favour of use. We recommended against using quetiapine, haloperidol, lithium, or carbamazepine because of the poor quality of evidence and their major adverse effects.

conclusionWhen severe disruptive or aggressive behaviour occurs with ADHD, medications for ADHD should be used first. Other medications have major adverse effects and, with the exception of risperidone, very limited evidence to support their use.

Indexed as

AdolescentAggressionAttention Deficit and Disruptive Behavior DisordersAttention Deficit Disorder with HyperactivityCanadaChildConduct DisorderHumansPractice Guidelines as Topic

Identifiers

PMID25886657
PMCPMC4344948

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.