This care recommendation produced by Drew H. Barzman (Assistant Professor of Pediatrics and Psychiatry at Cincinnati Children’s Hospital Medical Center) sets out to answer the following question: Among children with ADHD and aggression, is the pharmacological treatment of ADHD, versus no pharmacological treatment of ADHD, effective in reducing aggressive behaviour?

The authors searched Medline, PsychInfo, the National Guidelines Clearinghouse, and the Cochrane Database of Systematic Reviews for meta-analyses, systematic reviews, or practice guidelines related to the treatment of aggression in children and adolescents with attention deficit hyperactivity disorder.

The care recommendations and the levels of evidence that support them are as follows:

1. It is strongly recommended that appropriate pharmacological treatment for ADHD be first-line pharmacotherapy for aggression in children and adolescents with ADHD (High evidence).
2. It is recommended that children and adolescents be advised to seek psychotherapy in addition to the pharmacological treatment of ADHD and aggression (Moderate evidence).
3. It is recommended that when psychosocial interventions and ADHD medications are effective in the control of core ADHD symptoms but fail to reduce aggression, risperidone be added to current treatment (Low to moderate evidence)

List BA, Barzman DH. Evidence-based recommendations for the treatment of aggression in pediatric patients with attention deficit hyperactivity disorder (PDF). Psychiatr Q. 2011 Mar;82(1):33-42.