in children),9 others recommend psychostimulants as first-line treatment without any distinction between methylphenidate and amphetamines being made.10, 11 Additionally, the non-psychostimulant atomoxetine is variously recommended by available guidelines as third-line,9 second-line,10, 11 and potentially first-line treatment.12 The methods used for sequencing these recommendations are not always specified and most commonly—including the 2018 UK National Institute for Health and Care Excellence (NICE) guidelines9—incorporate national drug licencing regulatory approval and cost-effectiveness with expert opinion in conjunction with the few head-to-head comparisons that are available.
