However, studies have shown that oppositional and conduct symptomatology, aggressive behavior, peer interaction and sibling and family interaction may also benefit from stimulant medication. Stimulant side effects of decreased appetite, initial sleep difficulty, headaches, stomachaches and irritability are essentially the same across the various stimulants. Development of tics may be enhanced by stimulant medication and initially there may be a worsening of tics in those with preexisting tics. Gadow and colleagues' recent work suggests that most of these children will return to baseline tic situations if the stimulants are continued over time. Longer-acting drugs might have a smoother onset and offset.
Stimulants clearly are the treatment of choice.
However, there are children who do not respond to stimulants or who have intolerable side effects. General agreement exists that none of the second-level drugs produces a positive benefit in as great a number of children as do the stimulants. Some, such as the neuroleptics, are not used at all. Some, such as the heterocyclics, have been shown to improve functioning at least in behavior in a substantial number of children. However, the side-effect profile makes them much less preferred than the stimulants.