Pharmacological Treatments for Attention-Deficit/Hyperactivity Disorder and Disruptive Behavior Disorders

More than 225 placebo-controlled type 1 investigations demonstrate that psychostimulants are highly effective in reducing core symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adults. In contrast, there are limited type I studies demonstrating that psychopharmacological management with U.S. Food & Drug Administration-approved agents for ADHD (stimulants and nonstimulants), atypical antipsychotics, and mood stabilizers decrease the defiant and aggressive behavior characteristic of disruptive behavior disorders. Stimulant treatment evidence has been supplemented by two large multisite randomized controlled trials. Randomized controlled trials from the past 15 years continue to report several key adverse events associated with stimulants but have not supported rarer and more serious problems. Although psychostimulants have been shown to retain their efficacy for as long as 14 months, their long-term academic and social benefits are not as robust. Nonstimulant agents for which there is more limited evidence of efficacy include atomoxetine, alpha-agonists, modafinil, and bupropion.