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Treatment Options for Attention Deficit Hyperactivity Disorder

Slide: 15 of 31

Long-Term (>1 Year) Effectiveness of ADHD Interventions in People 6 Years of Age or Older: Pharmacologic

Psychostimulants provide control of ADHD symptoms and are generally well tolerated for months to years at a time. Overall, the benefits and safety of MPH for symptom control and general functioning are clearly documented, primarily for boys 7 to 9 years of age at initiation with the combined type of ADHD. There are many similarities between MPH immediate release and other preparations of psychostimulants, both in terms of efficacy and in the side effect profile. Therefore, many researchers and clinicians assume all psychostimulants are effective and safe for extended periods of time; however, the documentation for this assertion is not yet robust.

Strength of evidence: Low

Long-term extension trials show that ATX is both safe and effective for treating ADHD symptoms in children and teens over a period of 12 months. These studies offer direct comparison with placebo for the examination of relapse prevention, offering clear evidence of effectiveness in children and teens.

Strength of evidence: Low

Only one study of extended-release guanfacine (GXR) monotherapy is available. It reports reduced ADHD symptoms and global improvement with GXR, although less than a fifth of participants completed 12 months of treatment. Extension trials suggest that while GXR appears to be an effective treatment, high rates of adverse effects interfere with its use. Thus GXR does not appear to be as well accepted as a long-term treatment for ADHD in children as either psychostimulants or ATX. More studies are needed to permit an evidence-based conclusion about the long-term effectiveness of GXR.

Strength of evidence: Insufficient