guanfacine as first line treatment for 6 year old

[Brazilianmom]

Hi everyone

My son is 6 and got diagnosed with ADHD last September. 1 st grade has been hard, he is learning well, he is not defiant and overall a happy kid. His impulsive behavior in class has really affected his social life and the label of "bad kid" is sticking to him quickly. He has poor body control so ends up falling off his chair, hitting his friends by accident, bothering his friends sitting by him by being disruptive. His school and teachers have been great and give him a lot of grace. They have made many adjustments to help him and for that I am grateful.

After a few months on the waiting list, he was finally seeing by a psychiatrist. I really liked him. He also started CBT. We have seen improvements with his handwriting, but he still struggles with following directions, sitting still, poor social skills and overall body control.

The psychiatrist prescribed guanfacine (1 mg in the morning) as his first line of treatment. I know non stimulants are usually not the first line of treatment (per guidelines). We had a lengthy discussion about the rationale for his choice of first therapy, which I agreed , even though as a pharmacist I am aware of the guidelines. Anyone here has experience with guanfacine or starting ADHD treatment with non-stimulants as first line treatment? I would love to hear about your experience.

I know he needs pharmacological help, I know the value of proper therapy, but as a mom I feel sad and afraid of the journey ahead for him.

[Hidden]

I’d say I’d be so happy had my son’s doctor been so open minded with my son when my son was diagnosed. I am hearing what you are saying you being a pharmacist. I also read for myself BNF and nice.org.uk guidelines so I know exactly that stimulants are first line of treatment. But I think there are pieces of the puzzle missing when reading all the research and all- for example on the UK decision is made not only on efficacy but also cost (because those guidelines are for NHS) and Methylpenidate (Medikinet XL is very cheap) so it also shapes the decision why it is first line of treatment.

Also if you have access to this information you can check for yourself that already countries such a Japan have new guidelines and they say that both stimulants and non stimulants can be first line of treatment and it’s for parents and doctor to decide.

When they do those clinical trials they ask people to ignore the side effects as long as possible in order to complete the trial so I’d say maybe stimulants are best for focus (maybe that’s why this was often given to the soldiers? ) but what about ‘rebound’ and suppressed appetite and lack of sleep, increased anxiety and even link with depression. Children shouldn’t be put through this, for my son in it was the worst 8 months in his life.

Saying that I have read here that many kids in the US have multi pharmacotherapy and for many it works well it sees - so let’s say very small mg stimulant in the morning and then in the afternoon. Guanfacine etc. and even some parents on this forum were saying that their child is on Atomoxetine in the morning and then Guanfacine or Kapvay in the afternoon. And the kids are doing well supposedly. I suppose these non stimulants work on different neurotransmitters. I am not sure where you are (which country) and if your child’s doctor agree on multi medication for kids.

In the UK doctors are very conservative and they want mono therapy with one ADHD medication only. The argument is that there were no clinical trials and longitudinal follow ups on multi-pharmacology in children with ADHD.

Luckily my son is fine on Atomoxetine so for now we stick with that.

[Brazilianmom in reply to Hidden]

thank you for your reply . His psychiatrist also sides on the conservative approach . His rationale was that eventually he will need an stimulant and drugs like Guanfacine have a pediatric label only (12 and younger ). They do work in different neurotransmitter but non stimulants have a less harsh side effect profile but unfortunately sometime less effective . My sim also has asthma and some of his asthma meds may interact with stimulants

[Hidden in reply to Brazilianmom]

I have an impression that you have a good doctor who actually thinks about your child’s needs (this is opposite to our first doctor…).

I personally think it’s a myth that stimulants are best for all people with ADHD.

Especially what you say that your child is still young and it’s more of a wriggling in a chair and being disruptive in the class so he definitely doesn’t t need stimulants for that.

I agree, if someone is a university student or a high school student and needs to be completing assignments on deadlines and improve their working memory and memorise stuff for exams and make themselves ‘interested’ and ‘motivated’ to learn large amounts of ‘uninteresting’ stuff for exams, then yes, stimulants will help with that better than non stimulants. It might be that such student will actually benefit from the fact that they don’t feel sleepy nor hungry as they can just sit for hours and be completing those assignments and be focused (hyper focused…) and motivated.

We don’t need that level of functioning for small kids. We need our kids with ADHD to enjoy their lives, sleep well, eat well, have fun at school, be sociable, control their emotions and their body, be happy and free of anxieties and follow instructions from the teachers. Non stimulants (when well adjusted) do all that far better than stimulants. That is my personal opinion.

[Brazilianmom in reply to Hidden]

I was so impressed by this doctor . He asked about our goals hopes and dreams for our son at the age he is at now .

Thank you for your encouraging replies

[Imakecutebabies]

My 6yo started guanfacine as first line of treatment. For him, it was because the biggest symptoms that needed treating were his emotional regulation, which it has helped with. He still has trouble with impulsive behavior and poor body control, but is no longer reacting angrily to every little thing.