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Study: Supplementing Stimulants with Guanfacine May Improve Executive Functions in Children

If a stimulant medication alone isn’t adequately managing a child’s ADHD-related executive function deficits, new research suggests that adding guanfacine to his or her treatment plan may help.

February 12, 2018

Children with executive function deficits — impairments to planning motivation, and self-regulation skills — in addition to attention deficit disorder (ADHD or ADD) may benefit from taking the non-stimulant medication guanfacine alongside their existing stimulant regime, according to a small study.1

The study, published January 9 in the Journal of Attention Disorders, selected 50 children between the ages of 6 and 12 who had responded “inadequately” to stimulant medication in the past. All of the children had been diagnosed with ADHD, and had been taking stimulants for at least 30 days. The 50 children were randomly assigned to add either guanfacine or a placebo to their treatment regime for an 8-week period; after a 3-week “wash out” period, 39 of the children switched to the other treatment for comparison purposes.

The children treated with guanfacine showed significant improvements to their executive functions, as measured by the BRIEF-P executive function scale and the ADHD Rating Scale-IV. Both scores improved by at least 30 percent for twice as many children taking guanfacine as they did for those taking a placebo.

The results, though preliminary and based on a small sample, may open up new treatment pathways to patients who feel that stimulant medications don’t completely manage difficult symptoms, the study’s author said.

“Despite their effectiveness, treatment with stimulants sometimes results in inadequate response in symptom control,” said author Judy van Stralen, M.D., in an interview with MD Magazine. “Such lingering ADHD symptoms clinically results in patients having ongoing functional impairment including executive function deficits.

“Although some people may question the addition of a second dosage, adjunctive therapy medication is not unusual to treat medical conditions,” she continued. “If ADHD symptoms are better controlled, it can lead to a reduction in the functional impairment — which is the ultimate goal of treatment.”

1 Van Stralen, Judy P. M. “A Controlled Trial of Extended-Release Guanfacine and Psychostimulants on Executive Function and ADHD.” Journal of Attention Disorders, 9 Jan. 2018, doi:10.1177/1087054717751197.

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