There are many effective interventions that parents and teachers can use together with medication to manage aggressive behavior in kids with ADHD.

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children in the United States. In fact, about 11 percent, or 6.4 million children, ages 4 to 7, have ADHD, according to the Centers for Disease Control and Prevention.

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Children with ADHD have trouble sustaining attention. They are overly active and they may act impulsively. What’s more, they may act aggressive, angry, and defiant.

But parents and teachers can manage this aggression without relying solely on medications.

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Why is it so complex to deal with aggression and defiance in children with ADHD?

ADHD is often complicated by co-existing conditions, making effective treatment more difficult.

Russell A. Barkley, Ph.D., an ADHD expert and co-author of “Your Defiant Child: Eight Steps to Better Behavior,” told Healthline that the majority of children with ADHD struggle with aggression and emotional control.

“A significant 45 to 85 percent of kids with ADHD develop oppositional defiant disorder (ODD), averaging about 65 percent across studies,” Barkley said. “Physical aggression is somewhat less,” he added, “but still an impressive 25 to 45 percent, depending on the study.”

Emotional outbursts and physical aggression are not easily controlled when a child has ODD, and this behavior can cause a lot of stress for families.

Many parents of children with ADHD have tried traditional parenting strategies that rely on cause-and-effect discipline, and many have found these strategies aren’t effective for kids with ADHD.

Many children do outgrow aggressive and defiant behaviors, but it could take 10 years or more. Barkley said the best opportunity for successful intervention for these troubling behaviors is when kids are young.

“By age 12, the response rate drops to less than half. If you simply wait and see if they outgrow this, the damage done to their lives can be irreparable,” he explained.

A new study published in September in the Journal of the American Academy of Child andAdolescent Psychiatryshows that adding a common antipsychotic medication, risperidone (Risperdal), to the usual treatment of ADHD stimulant medication plus parent training can reduce aggression more than stimulants and parent training alone.

While the combination of stimulants, parent training, and risperidone has been shown to be an effective course of treatment, nonmedical interventions are useful as well.

“End your child’s defiant relationships … through organized and supervised activities, such as sports and clubs,” Barkley advised.

Second, aggressive children need individual therapy to learn to better manage their impulses and emotions. Helping children improve their academic performance through tutoring may also lead to more confidence and less defiant behavior.

Another promising treatment for aggression, known as mindfulness, involves creating and maintaining “moment-by-moment” awareness of our thoughts, feelings, bodily sensations, and environment. A study published in 2007 in the Journal of Emotional and Behavioral Disorders showed that learning and practicing mindfulness can help adolescents focus on and positively address a situation that may have otherwise caused aggressive behavior.

In a separate study, published in Psychology Report, researchers looked at the frequency of ADHD symptoms in children in the classroom compared to the same symptoms with a private tutor.

They had teachers and tutors complete the same ADHD rating scales commonly used in diagnosis. They found that both ADHD behaviors and oppositional behaviors, such as refusing to comply or disrespecting the teacher, are reduced in one-on-one sessions versus in a classroom.

Teachers should clearly and consistently explain to students what type of behavior is expected of them. They should also make children aware of the consequences when these expectations are not met and provide positive rewards and feedback when they are.

A self-described “veteran” parent of a son with ADHD, Penny Williams is an award-winning blogger and author of the Amazon best-seller, “Boy Without Instructions: Surviving the Learning Curve of Parenting a Child with ADHD.” Her second book, “What to Expect When You’re Not Expecting ADHD,” will be available January 2015.