improves patient satisfaction and compliance with medication

■ EVIDENCE-BASED ANSWER Stimulant medication therapy is the most effective treatment for attention deficit/hyperactivity disorder (ADHD) in children, producing significant improvements in symptoms and modest improvements in academic achievement (strength of recommendation [SOR]: A, based on multiple randomized controlled trials [RCTs]). Nonpharmacologic therapies, such as behavior therapy, school-based interventions, and family therapy, are not as effective as stimulants but may add modest benefit to the effects of medication (SOR: B, based on 1 RCT). While atomoxetine (Strattera) improves the symptoms of ADHD (SOR: A, based on multiple RCTs), stimulant medications other than methylphenidate offer no distinct short-term advantages (SOR: A, based on meta-analyses of multiple RCTs). Combination drug therapies offer no significant advantage to stimulants alone unless a comorbid condition is present (SOR: A, based on a meta-analysis of 20 RCTs). The combination of methylphenidate and clonidine (Catapres) improves symptoms in children with both ADHD and tics (SOR: B, based on 1 RCT). Clonidine is less effective alone and has significant side effects (SOR: B, based on a metaanalysis of nonrandomized trials).