Is there a better choice than stimulant medications for management of hyperactivity and lack of focus in patients diagnosed with autism? — JEAN LEE-MOSIER, FNP-C, Adams, N.Y.

In its clinical practice guideline on the treatment of children with ADHD, the American Academy of Pediatrics recommends stimulants as the first, second, and third choice of drug therapy based on a multitude of clinical trials. Only when stimulant medication, behavior therapy, and re-evaluation for accuracy of diagnosis or comorbidities have failed are such second-line therapies as atomoxatine, antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors), or alpha-2 adrenergic agonists (e.g., clonidine or guanfacine) recommended (Pediatrics. 2001;108:1033-1044, and Drugs. 2010;70:15-40). However, the upcoming DSM-V will likely update the criteria for diagnosis of ADHD and possibly change recommended treatment as well (Pediatric News. 2009;43:1, 4). — Julee B. Waldrop, MS, PNP (139-10)