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 ...

Completely agree with Dr. @Dr. First Last. The quoted PATS study provides robust safety and efficacy data for young elementary and even older preschoolers for psychostimulants, specifically methylphenidate, establishing this drug as 1st choice pharmacotherapy. Clearly, accurate diagnosis is critical...

Guanfacine is my preferred starting medication for young children. There are several reasons. First, hyperactivity is often more prominent at the younger ages, and guanfacine does a good job in that area. Second, stimulants have potential growth-interfering effects, which guanfacine does not. Third,...