This study aims to review the evidence for the efficacy of risperidone in the treatment of disruptive behavioural disorders (DBDs) in children and adolescents. Established databases were searched using the terms ‘Risperidone and efficacy and children’ and ‘Risperidone and efficacy and adolescents’. Randomised, double-blind controlled studies were retained for analysis. Janseen-Cilag was contacted to identify any unpublished studies. Quality of studies was measured using Jadad scores. Seven studies of 657 subjects with a mean age of 9.9 years (SD= 2.0) (range 4–18 years) were identified. Only one study was judged to use the highest quality of methodology according to the Jadad score. Patients with DBD who were treated with risperidone showed clinical improvement compared with placebo. Weight gain, somnolence and gastrointestinal complaints were common. Risperidone was found to be efficacious in reducing symptoms in children and adolescents with DBD. However, studies were mostly of short duration and had deficiencies in the descriptions of blinding and randomisation. Research using rigorous methodology examining the long-term outcomes of efficacy and safety are required to inform clinicians and families of the therapeutic benefits and risks of risperidone in this clinical population.