Conduct Disorder Clinical Trial
Official title:
The Assessment of Efficacy and Tolerability of Methylphenidate vs. Risperidone in the Treatment of Children and Adolescents With ADHD and Disruptive Disorders
Attention Deficit/Hyperactivity Disorder (ADHD) is one the most prevalent mental disorders
among children and adolescents, with a prevalence of 5% in western culture. The basics of the
disorder: inattentive and hyperactive/impulsive behaviors that manifest in a variety of
settings causing a dysfunction in everyday life. ADHD can be subdivided into three sub-types:
predominantly inattentive, predominantly hyperactive/impulsive or combined type. Common
co-morbidities of ADHD are disruptive disorders; Oppositional defiant disorder (ODD) being
the major one with about half of children with the combined sub-type ADHD and about a quarter
of children with the predominantly inattentive also suffering from ODD. Conduct disorder is a
co-morbidity for about a quarter of children with the combined sub-type ADHD. The
co-occurrence of these disorders is thought to have a negative effect on the outcome of both
of them.
Methylphenidate (MPH), short or long acting, is the mainstay of medical treatment for ADHD
patients, it's efficacy proven in a variety of studies. It should be noted that MPH has also
been proven to have a beneficial effect on children with disruptive behaviors. For children
with disruptive disorders Risperidone is the mainstay of medical treatment, and has been
proven in clinical trials.
To the best of their knowledge, a "head to head" study comparing these two drugs for the
treatment of pediatric patients with ADHD and co-morbidity of disruptive disorders was never
done before. The investigators aim is to examine the efficacy and tolerability of MPH vs.
Risperidone in this population. In addition, the investigators will apply DSM5's cross
cutting symptom measures scales is order to further define this unique subset of patients.
Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the latest version of the
diagnostic and statistical manual (DSM5). It's main features: sever recurrent temper
outbursts that are inconsistent with developmental level and occur on average three times a
week, the outbursts occur in at least two settings and the mood between outbursts is
irritable or angry. This diagnosis is in the differential diagnosis of ADHD with disruptive
disorders.
Secondary study aims:
1. Comparing the efficacy and tolerability of MPH vs. Risperidone in the treatment of
depressive symptoms in children and adolescents with ADHD and disruptive disorders.
2. Comparing the efficacy and tolerability of MPH vs. Risperidone in the treatment of manic
symptoms in children and adolescents with ADHD and disruptive disorders.
3. Comparing the impact of MPH vs. Risperidone on overall every day functioning of children
and adolescents with ADHD and disruptive disorder.
4. Comparing the impact of MPH vs. Risperidone on nighttime sleep of children and
adolescents with ADHD and disruptive disorder.
5. Comparing the impact of MPH vs. Risperidone on weight and height of children and
adolescents with ADHD and disruptive disorder.
6. Assessing the overlap between the diagnosis of ADHD and disruptive disorders and DMDD.
7. Assessing mood disorders and response to MPH vs. Risperidone treatment in children and
adolescents with ADHD and disruptive disorder.
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