Overview of pharmacotherapy for attention deficit hyperactivity disorder in children

Nonpharmacological management is first line for attention deficit hyperactivity disorder (ADHD) in children. Pharmacotherapy may be added, depending on the child’s age, as part of an individualised, multimodal management plan. The plan should outline the treatment approach and developmental goals. Pharmacotherapy should be prescribed by a clinician with expertise in using psychotropics in children—follow the principles of psychotropic use in children.

Because of the adverse effects associated with drugs used to treat ADHD in children, take baseline measurements, such as height, weight, heart rate and blood pressure before starting pharmacotherapy (see also Monitoring during drug treatment of ADHD).

Stimulants are first-line drugs for the treatment of ADHD in children.

Atomoxetine may be used if a stimulant cannot be used, is not tolerated, when there is comorbid Tourette syndrome or a severe anxiety disorder, or there is a risk of misuse of stimulants (either by the child or the adult supporting the child).

Guanfacine is usually reserved for children with ADHD who do not tolerate stimulants, or as an adjunct to a stimulant in children who have had an inadequate response. Guanfacine is also useful in children with a comorbid tic disorder (eg Tourette syndrome).

Clonidine has a similar role to guanfacine but its use is limited by its short half-life, which necessitates multiple-daily dosing.

The optimal duration of pharmacotherapy for ADHD is unclear—review the need for ongoing treatment in children at least once a year (see Duration of pharmacotherapy for ADHD).