Guanfacine extended-release use in diagnostic diversity and symptom complexity

This retrospective chart review examined clinical changes in ADHD symptoms and global functioning following guanfacine extended-release (GXR) initiation in a diagnostically heterogeneous clinical sample of children and adolescents with ADHD.

Thirty-eight children and adolescents aged 6-18 years with ADHD, with or without comorbid neurodevelopmental or psychiatric conditions, who were prescribed guanfacine extended-release were included in the tolerability analysis. Pre-post clinical outcome analyses were conducted in 33 patients who continued GXR for at least three months and had follow-up scale assessments available between weeks 4 and 12 after treatment initiation. Clinical data, including ADHD-related rating scales and autism-related clinical measures, were obtained retrospectively from medical records. Diagnoses were based on DSM-5 criteria, and psychiatric comorbidities were assessed using K-SADS-PL.

Of the participants, 76.3% were male. All participants had ADHD, and 63.2% had comorbid ASD. The mean final weight-adjusted GXR dose was 0.05 ± 0.03 mg/kg/day. Adverse effects were reported in 28.9% of patients, most commonly restlessness. Among 33 patients with follow-up assessments obtained between weeks 4 and 12, median CGI-S scores decreased from 5 to 3, while GAS scores increased from 55 to 75. ADHD symptom ratings decreased in most Turgay scale subdomains, particularly attention deficit, hyperactivity/impulsivity, and oppositional defiant symptoms.

Guanfacine extended-release use was associated with improvements in ADHD symptom ratings and global functioning in this retrospective clinical sample. Adverse effects were observed in a clinically relevant subset of patients and led to discontinuation in some cases. Given the retrospective design, lack of a control group, small sample size, and concomitant medication use, these findings should be interpreted as preliminary real-world observations.