The NIMH Multimodal Treatment Study of ADHD found that children with ADHD and disruptive behavior disorders benefit from stimulant treatment, showing a significant decrease in aggressive behaviors (Kunwar et al. 2007). Nevertheless, behavioral intervention is recommended to promote social integration and academic performance. Though stimulants may be an effective treatment for aggressive or antisocial behavior in ADHD, ► mood stabilizers or atypical ► antipsychotics have become widely used with the intent of treating manic symptoms or aggression. Concerns are being raised regarding the serious potential for metabolic derangements with such treatments, especially with certain atypical antipsychotics. Stimulants exacerbate psychotic symptoms in a sizeable proportion of such patients. While stimulants may be modestly helpful for children with learning disabilities without prominent hyperactivity/impulsivity, they are never sufficient. Such children require additional educational support. Coexisting anxiety appears to attenuate impulsivity in ADHD. Contradictory results regarding stimulant response in ADHD children with comorbid anxiety have been reported by well designed studies, with both poorer and equivalent response being found. Systematic studies have not examined the extent to which children with ADHD/depression or with ADHD/bipolar disorder can benefit from stimulants, although stimulants in conjunction with antidepressants have been recommended in cases of ADHD/major depressive disorder. Finally, anti-tic agents in combination with stimulants can be useful for children with ADHD and tic disorders.
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