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 .
Effects of Guanfacine Extended Release on Oppositional Symptoms in Children Aged 6–12 Years with Attention-Deficit Hyperactivity Disorder and Oppositional Symptoms
Abstract Objective : To evaluate the efficacy and safety of guanfacine extended release ( XR , Intuniv ™ ; Shire Development Inc. , Wayne , PA , USA ) in the treatment of oppositional symptoms in children aged 6–12 years with a diagnosis of attention-deficit hyperactivity disorder ( ADHD ) and the presence of oppositional symptoms . Subjects and Methods : In this r and omized , double-blind , placebo-controlled , multicentre , flexible-dose , dose-optimization study , children aged 6–12 years were r and omized to receive guanfacine XR ( 1–4mg/day ) or placebo for 9 weeks . Screening and washout periods were followed by a 5-week dose-optimization period , a 3-week dose-maintenance period and a 1-week tapering period . The primary efficacy measure was change from baseline to endpoint in the oppositional subscale of the Conners ’ Parent Rating Scale-Revised : Long Form ( CPRS-R : L ) score . Change in ADHD Rating Scale IV ( ADHD-RS-IV ) total score was a secondary efficacy measure . Safety assessment s included adverse events ( AEs ) , vital signs , ECG readings and laboratory studies . Results : A total of 217 children were enrolled : 138 were r and omized to receive guanfacine XR and 79 to receive placebo .  Least-squares mean reductions from baseline to endpoint in CPRS-R : L oppositional subscale scores were 10.9 in the guanfacine XR group compared with 6.8 in the placebo group ( p<0.001 ; effect size = 0.59 ) . A significantly greater reduction in ADHD-RS-IV total score from baseline to endpoint was also seen in the guanfacine-treated group compared with the placebo group ( 23.8 vs 11.5 , respectively ; p<0.001 ; effect size = 0.92 ) . A post hoc correlation analysis between percentage reduction from baseline to endpoint in CPRS-R : L oppositional subscale and ADHD-RS-IV total scores indicated that the decreases in oppositional symptoms and ADHD symptoms were highly correlated ( r = 0.74).The most commonly reported , treatment-emergent AEs ( TEAEs ) in the guanfacine XR group were somnolence ( 50.7 % ) , headache ( 22.1 % ) , sedation ( 13.2 % ) , upper abdominal pain ( 11.8 % ) and fatigue ( 11.0 % ) and most were mild or moderate in severity . TEAEs of sedation , somnolence or hypersomnia were experienced by 62.5 % of subjects in the guanfacine XR group . These events were most common during the dose-titration period but most ( 63.5 % ) resolved prior to the taper period . TEAEs of fatigue , lethargy and asthenia were reported in 11.0 % , 3.7 % and 0.0 % of subjects in the guanfacine XR group , respectively . Most subjects receiving guanfacine XR demonstrated modest changes in blood pressure , pulse rate and ECG readings that were not considered clinical ly significant . Conclusions : In this population of children aged 6–12 years with ADHD and the presence of oppositional symptoms , significant reductions in CPRS-R : L oppositional subscale and ADHD-RS-IV total scores were observed with guanfacine XR treatment compared with placebo . Treatment with guanfacine XR at optimized doses was associated with mostly mild or moderate TEAEs . The findings of this study support the efficacy of guanfacine XR in the treatment of children with ADHD and the presence of oppositional symptoms . Clinical Trial Registration Number : NCT00367835
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 .