A 7-year-old child with ADHD does not respond adequately to methylphenidate despite two dose optimisation trials. The non-stimulant option with the best evidence as an alternative in children and a specific FDA approval for ADHD is:

• A Bupropion
• B Atomoxetine (selective norepinephrine reuptake inhibitor) ✓
• C Imipramine (TCA)
• D Clonidine monotherapy

Explanation

Atomoxetine (Strattera) is the only FDA-approved non-stimulant specifically indicated for ADHD in children, adolescents, and adults. It is a selective norepinephrine reuptake inhibitor (selective NET inhibitor), with minimal dopaminergic activity, no abuse potential, and efficacy for both inattentive and hyperactive symptoms. It is the first-choice non-stimulant alternative to methylphenidate. Bupropion, TCAs, and guanfacine/clonidine have supporting evidence for ADHD but are not first-choice alternatives; clonidine ER (Kapvay) and guanfacine ER (Intuniv) have FDA approval as ADHD adjuncts. Atomoxetine's full effect may take 4–6 weeks.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.