α2-Adrenergic Agonists or Stimulants for Preschool-Age Children With Attention-Deficit/Hyperactivity Disorder

SPS commentary:

A related editorial discusses this research, stating that it is the first step toward filling the void in the evidence base regarding comparative effectiveness of medication treatment for preschool-age children with ADHD. Randomised clinical trials using standardised measures of efficacy and adverse effects at baseline and during treatment are needed among preschool-aged children to investigate effects of α2-adrenergic agonists as well as α2-adrenergic agonist/methylphenidate comparative effectiveness. This study found that preschool-age children treated with methylphenidate had elevated rates of irritability/moodiness compared with those treated with guanfacine, offering initial data to substantiate some specialist preference for guanfacine as the first medication choice in preschool-age children with ADHD who have significant symptoms of irritability and oppositionality. However to confirm this nascent signal, investigation of disruptive behaviours as moderators of effect in preschool ADHD treatment is necessary. Study of additional effect moderators is also crucial, because it is not known whether these findings will hold in samples of typically developing preschool-age children or among those with other specific comorbidity profiles (eg, autism spectrum disorder, various levels of intellectual disability/global developmental delay, specific neurodevelopmental genetic syndromes). Although much still needs to be learned regarding comparative effectiveness of medication treatment for preschool ADHD, this study provides the foundation for future study and its limitations provide a roadmap for next steps.

NICE NG87, Attention deficit hyperactivity disorder: diagnosis and management, recommends methylphenidate as first line pharmacological agent in children with ADHD