Current pharmacotherapy options for conduct disorders in adolescents and children

ABSTRACT

Introduction: Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD’s complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD).

Areas covered: The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children.

Expert opinion: Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.

KEYWORDS:

• Atypical antipsychotics
• conduct disorders
• risperidone
• pharmacotherapy
• children
• adolescents

Article highlights

• Atypical antipsychotics (e.g. risperidone) are effective in the management of conduct disorder (CD) in children and adolescents but should generally be reserved for those with more severe behaviors.

• The need for ongoing use of atypical antipsychotics should be reviewed on a regular basis as longer-term prescription carries significant risks.

• Metabolic parameters and EPSE’s should be monitored on a regular basis

• Other psychotropic medication may be useful if co-morbidites are present

• Psychosocial interventions should be part of any management plan for children and adolescents with CD.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.