[Indications for clonidine in child psychiatry]

The two principal indications of clonidine in child psychiatry are the "attention-deficit hyperactivity disorder" (ADHD) and Tourette's disorder. In the first case (ADHD), clonidine (4 to 5 micrograms/kg/day) is efficient (25 to 50% of improvement) with minimal untoward effects. The comparison between clonidine and methylphenidate (MPH) in this disease showed different actions of these two drugs on target symptoms: MPH preferentially acts in children with major attention-deficit and moderate hyperactivity whereas clonidine is more advocated in ADHD children with hyperarousal, hyperactivity and aggressivity symptoms. In Tourette's disorder, clonidine improves 30-50% of cases. Many studies have compared the efficiency of clonidine, neuroleptics and clonazepam. Clonidine is less efficient than neuroleptics such as haloperidol or fluphenazine but it is more efficient than clonazepam. Clonidine seems to be a good alternative to neuroleptics when these are not tolerated. Some authors recommend the association clonidine-clonazepam. Clonidine is very useful in Tourette's disorder associated with other syndromes such as obsessive-compulsive disorder, ADHD or withdrawal symptoms of neuroleptics. In contrast, clonidine has to be avoided in a depressive child. Clonidine in other psychiatric disorders such as infantile psychosis with hyperactivity, bipolar disorder, panic disorder, aggressivity and post-traumatic stress disorder has not been studied in children, but could be worth investigating.