Although students did their best to adapt to online learning due to COVID-19, it still had a substantial impact on children’s achievement. As students head back to school in the fall, it will be particularly crucial for children with ADHD to be well prepared to engage in learning effectively.
Understanding the Research
This retrospective study relied on data from 497 children from 7 outpatient developmental-behavioral pediatric practices across the country to assess the efficacy of treatment when initiated before the age of 6 years old with an A2A or stimulant medication for managing ADHD symptoms. Guanfacine and clonidine are examples of A2As, which were initially used to regulate blood pressure in adults before clinical trials confirmed they also improve concentration and address ADHD symptoms in school-aged kids. The research demonstrated that 62% of children had received behavioral therapy before medication was tried to treat ADHD. Aside from daytime sleepiness, kids reported fewer side effects with A2As than stimulants, in terms of moodiness/irritability, appetite suppression, difficulty sleeping, increased stomachaches and increased skin picking/repetitive behaviors. Despite the large and diverse sample size, retrospective medical record review methodology is a limitation of this study, as researchers were unable to ascertain the magnitude or time course of the benefits reported, the seriousness of side effects, baseline severity of ADHD issues, etc.
More Research Is Needed
Leela R. Magavi, MD, Johns Hopkins-trained child, adolescent, and adult psychiatrist and regional medical director for Community Psychiatry and MindPath Care Centers, says, “We require more research to compare the effects of stimulants and A2As in this age range. A2As can be an appropriate option. The findings of this study align with existing literature.” When medication is attempted to treat ADHD symptoms with children, Magavi explains that she always starts with methylphenidates and then transitions to amphetamines if warranted due to any side effects. “I use long-acting agents and add on immediate release if warranted for a longer duration of action. Patches, liquid formulations, and some capsules are helpful when kids have difficulty swallowing,” she says. Magavi emphasized the importance of assessing a child to learn about genetic predisposition, temperament, behavior, and life story prior to medication. For young children who are primarily impulsive and hyperactive, and if warranted due to functional impairment, she may consider using an A2A such as clonidine or guanfacine. These are medications that can be used alongside stimulants to minimize the stimulant dose. “A2As do not target inattention as well as stimulants do, and I explain this to parents who prefer non-stimulant options,” she says. Since A2As may be less likely to exacerbate anxiety concerns and may help to target anxiety symptoms, Magavi notes their benefits. “While stimulants can exacerbate sleep concerns, A2As are sedating and administered at night, and can consequently help target insomnia,” she says.
Another Tool to Treat ADHD
Behavioral health medical director at Community Health of South Florida, psychiatrist Howard Pratt, DO, says, “The takeaway for parents is that there are multiple ways to treat ADHD and there are multiple medications and behavior modifiers available as this is just one more tool in the toolbox.” While years of professional training and experience are needed to diagnose and treat ADHD, Pratt notes that sometimes parents may be told that their child has ADHD from a friend, family member, or teacher. He recommends that children should be seen by a professional who is licensed to diagnose ADHD and to prescribe these medications. “This study reaffirms that a correct early diagnosis and early treatment of ADHD can reshape a child’s future academically and socially for the better,” he says. Pratt says, “These A2As are not for treating all types of ADHD. Parents need to be aware that ADHD medications often carry a stigma and are looked down upon, but there is no such thing as an inherently evil medication. A2As are a great option for some children as are some of the stimulants.’’ While stimulants are typically the first line of treatment with medication for ADHD, Pratt notes that they also have side effects and can cause decreased appetite, sleeplessness, and for some kids, ADHD symptoms can worsen. “With A2As, the side effects profile is less and if the diagnosis is correct for using this medication, children will do better with it,” he says.
