For children under the age of 7 with ADHD who continue to have significant impairment with behavioral interventions, how do you decide between starting with a stimulant vs. starting with an alpha agonist?  

If the ADHD symptoms are still impairing despite being treated with behavioral interventions, pharmacotherapy is indicated. First-line pharmacotherapy for ADHD, even in elementary school age or younger, is stimulants. I would treat them with stimulants unless there is a contraindication or a reason ...

Accurate diagnosis is the critical first step in treating ADHD in young children, though it can be particularly challenging in this age group. ADHD remains a clinical diagnosis without a definitive test, and its symptoms often overlap with other conditions such as anxiety, depression, and PTSD. Alth...

1.) I agree, first of all, a good evaluation with the developmental history and the chronology of symptom onset. Comorbid diagnoses are also important to address. Typically, I agree with the recommendation of starting with stimulant first line, and then add or change to low-dose clonidine (if there...