Section - CAP Smart Takes

01. Adverse Effects of α-2 Adrenergic Agonists and Stimulants in Preschool-Age ADHD

Published on November 1, 2023 Certification expiration date: November 1, 2026

David R. Rosenberg, M.D.

Chair of the Department of Psychiatry & Behavioral Neuroscience - Wayne State University School of Medicine

Key Points

In preschool-aged children with ADHD, 80% on psychostimulants showed improvement compared with 66% on alpha-2 adrenergic agonists.
Psychostimulants had a higher overall rate of adverse events than alpha-2 adrenergic agents. However, alpha-2 adrenergic agents were associated with a higher rate of daytime sleepiness and headaches.

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Hi! David Rosenberg here for the Psychopharmacology Institute. In this CAP Smart Take, we will delve into the common and rare adverse effects associated with psychostimulant and alpha-2 adrenergic agents used to treat preschool-aged children diagnosed with ADHD. Recent insights show that ADHD can be diagnosed reliably in preschool-aged children. Although nonmedication behavioral interventions remain the primary recommended treatment for this group, methylphenidate is the next suggested pharmacotherapy when behavioral interventions fall short. Alongside medication, it is optimal to persist with psychosocial and behavioral interventions. Studies indicate that preschool-aged children are more susceptible to adverse events linked to methylphenidate compared with school-aged children. Additionally, they exhibit higher discontinuation rates. The utilization of alpha-2 adrenergic agonists, such as clonidine and guanfacine, has surged in this age group.

Loe and colleagues offered valuable insights, characterizing and contrasting the adverse effects of psychostimulant and alpha-2 adrenergic agonist treatment in preschool-aged children with ADHD.

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02. In Utero Exposure to ADHD Medication and Long-Term Offspring Outcomes

Learning Objectives:

Recognize that psychostimulants had a higher overall rate of adverse events than alpha-2 adrenergic agents in preschool children with ADHD.
Identify that exposure to ADHD medication during pregnancy does not increase the risk of ADHD or autism spectrum disorder.
Evaluate the potential benefits and limitations of adjunctive therapies, such as fish oil, in treating major depressive disorder.
Discuss the potential link between early childhood anesthesia exposure and subsequent ADHD risk.
Recognize that there is an increased risk of drug overdose when benzodiazepines are used for sleep disorders in youth.

Original Release Date: November 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: November 1, 2026

Expert: David Rosenberg, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.