# Ask about alpha-2 nonstimulant options Published by Pawel Jozefiak. [About this project](https://adhd100.jock.pl/about/), [How we check sources](https://adhd100.jock.pl/methodology/) - Canonical: https://adhd100.jock.pl/discuss-alpha2-child/ - Language: en - First published: 2026-09-29 - Evidence checked: 2026-09-29, using AI-assisted source verification - Clinical review: Not clinically reviewed - Number 11 of 100 in the list: https://adhd100.jock.pl/#discuss-alpha2-child A nonstimulant option for children, usually after stimulants. The rules for guanfacine and clonidine differ by country. **The number:** Children and teens: medium symptom improvement vs placebo over about 12 weeks (SMD 0.635) ([BMJ / Gosling et al., 2025](https://raw.githubusercontent.com/CorentinJGosling/EBI-ADHD-UR-2025/86eff22a9ffb/datasets/dataset-ur-adhd.csv)) ## The evidence - How sure: Certainty of evidence: High certainty. Measured in people with ADHD. - See this comparison on the evidence map: https://adhd100.jock.pl/evidence/#r-alpha-2-agonists-guanfacine-clonidine-youth-core-adhd-symptoms-clinician-rated-short - Evidence grade: A. Grade A: moderate or high certainty evidence in people with ADHD, or an explicit ADHD guideline recommendation. - Basis: EBI re-estimation: pooled alpha-2 class, 8 trials, 1497 children and adolescents, short term clinician ratings; adult class evidence very low certainty; NICE NG87 1.7.10 and 1.7.17 - Outcome: clinician-rated core ADHD symptom improvement in youth - Comparison: vs placebo - Benefit: 78/100. The benefit score is an editorial prioritization for the general list, weighted by certainty. It is not a prediction of what will happen for you. ## Why it matters Guanfacine and clonidine act on alpha-2 adrenergic receptors. EBI pooled the two and found clinician-rated symptoms in children and adolescents 0.635 SMD better than on placebo, with high certainty, but that rating covers only this youth result over about 12 weeks or to trial endpoint, and the adult evidence for the class is very low certainty. Pooling them does not make them interchangeable: NICE recommends guanfacine for children when stimulants were not tolerated or did not help, and clonidine only on specialist tertiary advice, while the AAP lists extended-release forms of both. The AAP names sleepiness, low blood pressure and a slow heart rate among the possible adverse effects. ## How to do it 1. Given how previous treatment went, ask your child's clinician whether an alpha-2 medicine fits. 2. Pin down which medicine and which formulation you are talking about, and whether it is licensed for this use where you live. 3. Ask who will check alertness, pulse and blood pressure, and how. 4. Check how it would sit alongside any other medicine your child is prescribed. ## Talk to a clinician first A specialist must choose and supervise the medicine, and in the UK clonidine is used only on tertiary specialist advice. Plan any change, stopping included, with the prescriber, because stopping suddenly can raise blood pressure. ## Putting it into practice ### Start now - 1 minute: Write down the one concern about a nonstimulant you want the clinician to answer. - 5 minutes: Write down your child's current medicines and any history of fainting or marked sleepiness. - 15 minutes: Write your questions about the proposed medicine, whether it is licensed locally, and monitoring. ### What it looks like - Ask how the clinic checks for daytime sleepiness or dizziness. - Bring a list of every medicine your child takes, so the clinician can check the combinations. ### Common mistakes - A pooled result for the class does not make the medicines interchangeable. Ask about the specific one on offer. - Sleepiness can be a side effect, not ADHD getting better. Report how your child is actually getting on. ### A structured start **Compare the option with your child's needs** 1. Summarise previous treatment and relevant health history. 2. Discuss the specific medicine and monitoring with the specialist. 3. Agree how your child will report benefits and adverse effects. ### Trusted how-to guides - [ADHD in children and young people](https://www.nhs.uk/conditions/adhd-children-teenagers/), NHS - [Tips for Talking With a Health Care Provider About Your Mental Health](https://www.nimh.nih.gov/health/publications/tips-for-talking-with-your-health-care-provider), NIMH ## Sources - [EBI-ADHD: companion data to Gosling et al., BMJ 2025, commit 86eff22a9ffb](https://raw.githubusercontent.com/CorentinJGosling/EBI-ADHD-UR-2025/86eff22a9ffb/datasets/dataset-ur-adhd.csv), BMJ / Gosling et al., 2025 (Tier 1 guideline) - [Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making](https://pmc.ncbi.nlm.nih.gov/articles/PMC12651917/), BMJ, 2025 (Tier 1 guideline) - [Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents](https://pmc.ncbi.nlm.nih.gov/articles/PMC7067282/), American Academy of Pediatrics, 2019 (Tier 1 guideline) - [Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations](https://www.nice.org.uk/guidance/ng87/chapter/Recommendations), NICE, 2019 (Tier 1 guideline) --- General information about ADHD, not a diagnosis or an individual treatment plan. Tailoring changes the order of suggestions; it does not assess you. Medication decisions belong with you and a qualified clinician. Report an error: meet@jock.pl Reuse: CC BY 4.0, https://creativecommons.org/licenses/by/4.0/