Treatment of ADHD should include adequate education of patients and their families, behavioural interventions, psychological treatments and educational accommodations first. If this approach is not sufficient, stimulant medication and a behavioural analysis to ensure appropriate support from the parent and classroom is indicated. The use of alpha 2 agonists (such as guanfacine) and atomoxetine should be considered before using atypical antipsychotics (such as risperidone) in children with disruptive behaviour disorders (oppositional defiant disorder, conduct disorder).

Conditions: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, Conduct Disorder

Treatments: Atypical Antipsychotics (AAP), Risperidone, Alpha 2 Agonists, Guanfacine, Atomoxetine

Sources

• Gorman DA, Gardner DM, Murphy AL, Feldman M, Bélanger SA, Steele MM, et al. Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder. Can J Psychiatry. 2015 Feb;60(2):62-76. (PubMed)
• Loy JH, Merry SN, Hetrick SE, Stasiak K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst Rev. 2012 Sep 12;9:CD008559. (PubMed)
• Pringsheim T, Hirsch L, Gardner D, Gorman DA. The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents With Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 1: Psychostimulants, Alpha-2 Agonists, and Atomoxetine. Can J Psychiatry. 2015 Feb 1;60(2):42-51. (PubMed)
• Wilkes TCR, Nixon MK. Pharmacological treatment of child and adolescent disruptive behaviour disorders. Can J Psychiatry. 2015 Feb;60(2):39-41. (PubMed)