Clonidine and Aripiprazole Use in Children

Introduction to Medication Use

The American Academy of Pediatrics recommends that in preschool-aged children (4-5 years), behavioral therapy alone should be initiated first before any medication for ADHD 1
The American Academy of Child and Adolescent Psychiatry suggests that medication is not contraindicated at age 5, but should be reserved for moderate-to-severe dysfunction that has not responded adequately to behavioral interventions 1

Clonidine has been studied in children as young as 5 years old for ADHD symptoms, with typical dosing of 0.15-0.20 mg divided three times daily 3, 2
For initiating clonidine, the recommended starting dose is 0.05 mg at bedtime, with gradual titration based on response, never exceeding 0.3 mg/day total 4
Common side effects of clonidine include hypotension, drowsiness, fatigue, and bradycardia, with bradycardia occurring in approximately 17.5% of children 3, 2

Aripiprazole has been studied in children aged 6-17 years for irritability, hyperactivity, stereotypy, social withdrawal, and inappropriate speech in autism spectrum disorder, with studied doses of 5, 10, or 15 mg/day 3, 2
Aripiprazole is NOT approved for children under 6 years of age, making it inappropriate for a 5-year-old 2
Clonidine has been studied in children aged 5-13 years with autism for hyperactivity, irritability, inappropriate speech, and stereotypy, with statistically and clinically relevant decreases in irritability scores 3, 2

The American Academy of Pediatrics recommends starting with behavioral therapy (parent training programs) for 8-12 weeks in children with ADHD 1
Clonidine is an option at age 5 for autism-related irritability, at a dose of 0.15-0.20 mg divided three times daily 3, 2
Aripiprazole should NOT be used at age 5 as it is only approved for ages 6 and older 2
Clonidine 0.05 mg at bedtime is appropriate for sleep disturbances, particularly if ADHD is also present 4