ADHD News & Research

Alpha-2 Adrenergic Agonists May Effectively Treat ADHD in Preschoolers with Fewer Side Effects

While stimulants are typically recommended to treat ADHD in young children, a new study suggests that alpha-2 adrenergic agonist medications (commonly in the form of guanfacine) may also effectively reduce ADHD symptoms in preschoolers with fewer side effects than stimulant medications.

May 11, 2021

Alpha-2 adrenergic agonists may effectively treat ADHD in preschoolers with fewer side effects than first-line stimulant medications, according to a new study published  in the Journal of the American Medical Association that claims to be the first to compare the two classes of ADHD medication in preschool-aged children.1

The health records of nearly 500 children (primarily males) revealed that 78% of children treated with stimulants showed an improvement in ADHD symptoms, while 66% of preschoolers who took an alpha agonist (like guanfacine) showed improved symptoms. However, participants taking the latter reported fewer side effects — namely, lower rates of moodiness/irritability, appetite loss, and difficulty sleeping. Dr. Tanya Froehlich, professor and research director at Cincinnati Children’s Hospital Medical Center, explained: “For young children with ADHD who haven’t had enough improvement with behavioral therapy, both methylphenidate and guanfacine appear to be effective in reducing ADHD symptoms for the majority of preschool-aged patients.”2

Researchers suggest that guanfacine may be an optimal choice for preschoolers who show signs of sleep difficulty, irritability, stubbornness, and defiance, however further research is needed. Professor Mary Soltano, a member of the advisory board for CHADD, suggested that alpha-2 adrenergic agonists are “reasonable options if your child has side effects from stimulants or needs something additional.”

She explained that the risks of either medication class do not outweigh the risks of untreated ADHD: “Untreated ADHD can yield a lot of problems with academic performance, social interaction, self-confidence, anxiety and depression. These kids become discouraged early and have higher rates of school dropout and underperform occupationally.”


1 Elizabeth Harstad, MD, developmental and behavioral pediatrician, Boston Children’s Hospital; Tanya Froehlich, MD, professor, pediatrics, Sonya G. Oppenheimer Endowed Chair and Director of Research, division of developmental and behavioral pediatrics, Cincinnati Children’s Hospital Medical Center; Mary Solanto, PhD, professor, pediatrics and psychiatry, Hofstra-Northwell School of Medicine, New Hyde Park, N.Y.; Journal of the American Medical Association, May 4, 2021

2 Mann, Denise. ADHD meds can help preschoolers, but effects vary. Medial Press (May 2021)