Efficacy of Alternative Medications to Stimulants for the Treatment of Youths with Attention-deficit–Hyperactivity Disorder

Jamie G Wood, JodyAnn S Jongeling
US Psychiatry, 2010;3:59-63
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Abstract

Numerous classes of non-stimulant medications used to treat attention-deficit–hyperactivity disorder (ADHD) are reviewed herein, with detailed discussions of appropriate uses, side effects, and the amount of research available to substantiate their use. Their utility in the treatment of common comorbid conditions is explored as well as efficacy comparisons with their stimulant counterparts. Additionally, a methodology for future investigations is provided along with potentially germane pathways to new discoveries.
Keywords
Attention-deficit–hyperactivity disorder, comorbid conditions, stimulants, children and adolescents
Disclosure The authors have no conflicts of interest to declare.
Received: December 07, 2008 Accepted February 15, 2009
Correspondence: Jamie G Wood, EdD, Pittsburg State University, 1701 South Broadway, Pittsburg, KS 66762. E: jwood@pittstate.edu

Attention-deficit–hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and adolescents. The disorder is technically a psychiatric disorder, although accurate diagnosis1 and effective treatment should involve collaboration between physicians, teachers, school psychologists, and other school personnel.2 While such group efforts are not required for physicians to make the diagnosis of ADHD, the use of a variety of instruments and procedures in patient evaluation and diagnosis is prudent.2 Pharmacotherapy (medications) is the most commonly recommended treatment for ADHD and has been shown to be the optimal intervention option in cases with no other comorbid disorders.3 Numerous resources document the efficacy of stimulants such as methylphenidate and others.4,5 However, findings suggest that nearly one in every four affected youths will not respond to these medications or will discontinue them due to side effects.6–8 This article will focus on alternative medications and emerging trends.

Antihypertensives

Clonidine (CLN) has been used to treat ADHD symptoms in youths. More than 25 studies have been completed to assess its efficacy and safety. Some earlier studies were limited by methodological concerns and small sample sizes.9 Within the last 20 years, studies involving more than 500 youths have shown that treatment with CLN has been moderately effective on symptoms of ADHD when used as monotherapy.10 However, newer research seems to indicate that CLN’s effectiveness may not match that of methylphenidate within a classroom setting based on teacher responses.11 In other research CLN has been shown to be effective when used in combination with stimulants to reduce sleep disturbances,12,13 lower aggression,14,15 and diminish tics.16,17 Other researchers also found that, when combined with stimulants, CLN can have a positive effect in reducing conduct disorder symptoms associated with ADHD.18 Children treated with CLN have been shown to have a higher rate of sedation compared with methylphenidate or placebo.11 Although drowsiness is common, these symptoms appeared to resolve within six to eight weeks of treatment.19

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Efficacy of Alternative Medications to Stimulants for the Treatment of Youths with Attention-deficit–Hyperactivity Disorder

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