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Long-acting stimulants Can be dosed once per day (can avoid administration at school) Side effects may extend later in the day Increased cost Fewer generic options Short-acting stimulant can be added in PM for afternoon boost when needed Single-pulse sustained release (eg, Ritalin SR®, Metadate ER®, Methylin ER®) Must be swallowed whole Sustained release bead preparations (eg, Dexedrine® Spansule®, Ritalin LA®, Focalin XR®, Adderall XR®, Metadate CD®) Approximates a twice-per-day dosing schedule Can be sprinkled into soft foods for children who have difficulty swallowing pills The beads should not be chewed Should not be taken with antacids or other drugs that decrease gastric acidity Ingestion with a high-fat meal may delay time of onset and increase peak concentration Osmotic release (eg, Concerta®) Approximates a three-times-per-day dosing schedule Children with decreased GI absorption or intestinal resection may not receive the full benefit Capsule should not be opened or chewed Capsule is passed through the GI tract and into the stool intact Patch (Daytrana®) Can be used for patients who cannot take oral medications Patch must be applied 2 hours before needed effect Early removal of the patch permits controlled duration (effects last approximately 2 to 3 hours after patch is removed) Prodrug (Lisdexamfetamine) May have lower risk for abuse Capsules can be opened and mixed with water for children who have difficulty swallowing capsules

Atomoxetine Can be dosed once per day Lower potential for abuse than stimulants Not a controlled substance May be less efficacious than stimulants Potential increased risk of suicidal ideation More time to steady state (up to 2 weeks for initial response; up to 8 weeks for maximal effect) "Drug holidays" are not an option Taking with food may prevent nausea Requires dosing adjustment if administered with agents that inhibit the cytochrome P450 2D6 (CYP2D6) enzyme

Extended release alpha-2-adrenergic agonists Not a controlled substance May also treat coexisting conditions (eg, sleep disorders, tic disorders) May be less efficacious than stimulants More time to steady state (up to 2 weeks for initial response) "Drug holidays" are not an option Must be swallowed whole, not crushed or chewed May lead to hypotension and orthostasis GI: gastrointestinal. Data from: Daughton JM, Kratochvil CJ. Review of ADHD pharmacotherapies: Advantages, disadvantages, and clinical pearls. J Am Acad Child Adolesc Psychiatry 2009; 48:240. Harpin VA. Medication options when treating children and adolescents with ADHD: interpreting the NICE guidance 2006. Arch Dis Child Educ Pract Ed 2008; 93:58. Drugs for treatment of ADHD. Treat Guidel Med Lett 2006; 4:77. Wigal SB. Efficacy and safety limitations of attention deficit hyperactivity disorder pharmacotherapy in pediatric patients. J Pediatr 2009; 154:S13.