Guanfacine Use in Children With Down Syndrome and Comorbid Attention-Deficit Hyperactivity Disorder (ADHD) With Disruptive Behaviors

J Child Neurol. 2016 Jul;31(8):957-64. doi: 10.1177/0883073816634854. Epub 2016 Mar 2.


The purpose of this study was to characterize children with Down syndrome and attention-deficit hyperactivity disorder (ADHD) with disruptive behaviors using the Aberrant Behavior Checklist (ABC), and to measure the treatment effects of guanfacine on maladaptive behaviors. Subjects were enrolled from a group of outpatients who visited our clinic between 2002 and 2007. Subjects (N = 23) were children with Down syndrome ages 4 to 12 years (mean 7.4 ± 4.1), who met criteria for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition The Aberrant Behavior Checklist Irritability and Hyperactivity subscales each showed a significant decrease (P < .0001) at follow-up. The mean decline on Hyperactivity was 25% (-7.8 points), and for Irritability, 25% (-3.5 points). The mean composite score also declined by 24% (-12 points). Effect size differences on Irritability were moderate, whereas differences on Hyperactivity and composite score appeared large. Clinically important target behaviors were reduced. Medication was generally well tolerated and the incidence of treatment emergent side effects remained low.

Keywords: Alpha2a-adrenergic agonist; Down syndrome; aggression; attention-deficit hyperactivity disorder (ADHD); disruptive behavior; guanfacine; intellectual disability.

MeSH terms

  • Adrenergic alpha-2 Receptor Agonists / adverse effects
  • Adrenergic alpha-2 Receptor Agonists / therapeutic use
  • Attention Deficit Disorder with Hyperactivity / complications
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Child
  • Child, Preschool
  • Comorbidity
  • Down Syndrome / complications
  • Down Syndrome / drug therapy*
  • Down Syndrome / epidemiology
  • Female
  • Follow-Up Studies
  • Guanfacine / adverse effects
  • Guanfacine / therapeutic use*
  • Humans
  • Irritable Mood / drug effects
  • Male
  • Problem Behavior*
  • Psychiatric Status Rating Scales
  • Psychotropic Drugs / adverse effects
  • Psychotropic Drugs / therapeutic use*
  • Treatment Outcome


  • Adrenergic alpha-2 Receptor Agonists
  • Psychotropic Drugs
  • Guanfacine