A2As or stimulants: which is better for treatment of ADHD in young children?

The use of α2-adrenergic agonists (A2As), like guanfacine and clonidine, in preschool-aged children with ADHD has been on the rise, even though little data support safety effectiveness for these medications this patient population. A May 2021 study conducted by Harstad colleagues published JAMA compared A2As stimulants childhood ADHD. Similar to other studies, research team found that both were associated improvement symptoms most between approximately 4 6 years whom they initiated, clinical 66% 78% young children, respectively. highlights potential role could play treating ADHD, said Elizabeth Harstad, MD, MPH, a physician at Boston Children's Hospital an assistant professor pediatrics Harvard Medical School. According American Academy Pediatrics (AAP) Society Developmental Behavioral (SDBP), firstline therapy is behavioral intervention, followed stimulant treatment methylphenidate (Ritalin) lowest effective dose if interventions are not sufficient. In general, AAP recommends first then medication treatment, necessary. Amphetamine salts (Adderall) FDA-approved as 3 because grandfathered in, there stronger evidence their methylphenidate, Michael Ellis, DO, child adolescent psychologist associate Mercer College Medicine Georgia. He more efficacy promote its use, it approved individuals older. “In I find less irritability prefer first, especially those autism spectrum disorder,” Ellis said. NIH's Preschool Treatment study, randomized, placebo-controlled ages 5.5 who treated had significant reduction symptoms, but often experienced adverse effects depressive crying sadness. retrospective, medical records examined 497 preschool-age younger than They came from seven academic developmental pediatric programs located diverse geographical locations across United States. “We pediatricians when initiating about two-thirds time,” Harstad. “Children younger, or coexisting sleep disorder, likely be initiated A2As.” Since A2As—like moodiness/irritability (50% vs. 29%, respectively), appetite suppression (38% 7%, difficulties (21% 11%, respectively)—some providers prescribe patients. “But focus [compared stimulants], can good deal somnolence hypotension,” Ellis. Daytime sleepiness was only effect common took versus 3%, according study. limitation retrospective nature, which resulted collection non-randomized non-controlled regarding level over time, severity baseline effects, “Medication may have influenced confounding factors [such conditions]. Therefore, clinically imperative conduct prospective assess effectiveness,” Preschool-aged being diagnosed higher rates ever before. 2018 article Journal Clinical Child & Adolescent Psychology, preschool risen 1.0% 2007 2.4% 2016. delay early detection lead expulsion preschool, future underachievement school, undue family stress, important parents evaluated on. “Preschoolers severe need right away,” While benefits risks treatments stimulants, options should assessed patient-centered approach optimize individual needs. Future controlled studies also needed classes determine conclusive results.