Our conclusions from this analysis concur partly with NICE guidelines,9 in which methylphenidate is recommended as the first choice in children and adolescents and methylphenidate or lisdexamfetamine as first choice in adults. Additionally, although NICE recommend atomoxetine or guanfacine as a possible third-line choice in children, our results suggest that, despite comparable efficacy on ADHD core symptoms rated by parents, atomoxetine was equal to placebo in terms of tolerability, whereas guanfacine was worse. However, it is noteworthy that the NICE recommendations were informed not only by empirical evidence but also by considerations on costs and licence and flexibility of formulations.
