ADHD drug class leads to fewer side effects in preschool children

ADHD drug class leads to fewer side effects in preschool children

A study comparing two types of ADHD medications in preschool-age children shows alpha-2-adrenergic agonists like guanfacine and clonidine are effective in reducing ADHD symptoms but with a lower rate of side effects.

About 2.4 percent of preschool-age children have an attention-deficit/hyperactivity disorder (ADHD) diagnosis. For these children, behavioral interventions intended to redirect a child or otherwise replace negative behavior with positive ones are the first line of treatment. But what if symptoms linger, or are so severe that they interfere with a child’s social, emotional, and educational development?

A study from Boston Children’s Hospital finds that starting drug treatment with alpha-2-adrenergic agonists (A2As), such as guanfacine and clonidine, can be effective in reducing ADHD symptoms in preschool-age children. Just as important, the study shows that these medications have fewer side effects than stimulants, like methylphenidate (Ritalin, Concerta) and amphetamines (Adderall, Vyvanse), which are often the first line of ADHD treatment.

A2As were initially used to regulate blood pressure in adults but then gained FDA approval to treat ADHD in school-aged children after clinical trials found they could improve attention and focus and reduce ADHD symptoms.

Results of this ADHD/A2A study are published in JAMA . It is the first analysis of the effects of both stimulants and A2As in preschool children.

One-third of children already taking A2A medications

A team from the Developmental Behavioral Pediatrics Research Network (DBPNet), which includes Boston Children’s, reviewed the medical records of nearly 500 children seen at seven outpatient developmental-behavioral pediatric practices. Elizabeth Harstad “We found that about 35 percent of preschool-age children with ADHD began drug treatment with A2A medications, even though little is known about their effectiveness and safety in this age group,” says lead author Elizabeth Harstad, MD, MPH , of the Division of Developmental Medicine at Boston Children’s. “Since these kids are already being prescribed these drugs, it was important to study their effectiveness and possible adverse effects.”

The median age of the children in the study was just over 5 years old; 82 percent were male.

A2As nearly as effective as stimulants

Of the 497 children in the study, 309 (62 percent) had first received behavioral therapy before initiating ADHD medication, in line with current ADHD treatment recommendations from the American Academy of Pediatrics.

Behavioral interventions for ADHD

Behavioral interventions are the first treatments recommended for ADHD in preschool-age children. They can include modifications in the physical and social environment that are designed to change behavior using rewards and nonpunitive consequences.

Examples involve: – maintaining a daily schedule – keeping distractions to a minimum – providing specific and logical places for the child to keep schoolwork, toys, and clothes – setting small, reachable goals – rewarding […]

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