An RCT6 of different doses of atomoxetine (Strattera) treatment vs placebo for children ages 8 to 18 (mean age=11) with ADHD alone (N=178) and children with both ADHD and ODD (N=115) found significant effect sizes for atomoxetine in both groups. Two dosages of atomoxetine (1.2 and 1.8 mg/kg/d) produced equivalent effect sizes in the ADHD-only group (0.55 and 0.56); however, the higher dosage had a greater effect size (0.49 vs 0.69) in the group with ODD comorbid with ADHD.
A double-blind crossover RCT7 evaluated divalproex (Depakote) vs placebo for 20 children (aged 10 to 18 years) with explosive temper and mood lability who also met DSM-IV criteria for either ODD or conduct disorder. Patients with significant medical problems, such as bipolar disorder, major depression, or mental retardation, were excluded. Divalproex significantly (P=.003) reduced aggressive behaviors and anger-hostility items by approximately 33% as reported by child, parent, school, and clinician on 2 standardized scales.
Experts say antidepressant medications may be helpful in treating children with conduct disorder and comorbid major depression.8
Recommendations by others
An international consensus statement on ADHD and disruptive behavior disorders (comprising ODD, conduct disorder, and disruptive behavior not otherwise specified) says that psychopharmacologic treatment would not be appropriate for cases of ODD in the absence of psychiatric comorbidity, unless severe aggression or destructive behavior persisted despite attempts at psychosocial interventions of established efficacy.4