Preschool Children with ADHD Often Treated with Alpha-2 Agonists

December 18, 2019

The Developmental and Behavioral Pediatrics Research Network (DBPNet) is studying the pharmacological management of preschool aged children diagnosed with ADHD in 7 outpatient developmental-behavioral pediatric programs at academic medical centers. The charts of over 500 children have been reviewed and demonstrate that stimulants are the initial medication prescribed in 65% of children and alpha-2 adrenergic agonists are the initial medications prescribed in 35% of children. Among the stimulant medications, methylphenidate-based stimulants were prescribed for 88% of children and amphetamine-based stimulants for 12%. Among the alpha-2 adrenergic agonist medications, guanfacine was prescribed for 89% of children and clonidine for 11% of children.

The Preschool ADHD Treatment (PATS) study was a large multi-site randomized controlled study that provides evidence to support the use of methylphenidate in preschool aged children. However, there are no studies that have focused on the use of alpha-2 adrenergic agonists to treat ADHD in preschool aged children with ADHD. Preliminary analysis of data from the DBPNet study demonstrate that children with ADHD co-occurring with autism spectrum disorder or co-occurring with sleep problems were the groups most likely to be prescribed alpha-2 adrenergic agonists. In addition the preschool aged children initially prescribed alpha-2 adrenergic agonists were more likely to be younger that those initially prescribed stimulant medications.

Ongoing analysis from this study will investigate the efficacy and side effects of these medications in preschool aged children with ADHD.