Nonstimulant therapies for attention-deficit hyperactivity disorder (ADHD) in children and adults

While stimulant medications are the primary pharmacological treatment for ADHD across the lifespan, a subset of patients with ADHD do not experience significant symptom relief from stimulants or can not tolerate effective stimulant doses. Psychosocial therapies, particularly behavioral modification techniques, should be considered for children with ADHD and oppositional behaviors, while Cognitive Behavioral Therapy (CBT) may be a helpful adjunct for adolescents and adults with ADHD. Among the nonstimulant medications, atomoxetine (Strattera) is the only the FDA approved option. It has been found to be efficacious for the entire spectrum of ADHD symptoms in both children and adults. However, daily compliance is essential, and it may take several weeks to achieve full therapeutic effect. Other nonstimulants that have been used to treat ADHD include bupropion (Wellbutrin), the alpha-2 agonists guanfacine (Tenex) and clonidine (Catapres) as well as the tricylic antidepressants. Modafinil (Provigil) is actively being studied for the treatment of pediatric ADHD, and there has been some preliminary studies assessing the efficacy of cholinergic agents for ADHD. Recently, there has been increasing interest in combining nonstimulant therapies with stimulants to further enhance treatment effects. However, more controlled data on the safety and efficacy of combining pharmacological therapies are needed.