How do you approach stimulant-related insomnia for pediatric patients who are otherwise good responses to low-dose stimulant treatment for ADHD?  

Clonidine 0.1mg qhs is my first choice if I have to use something. However, first consider decreasing the stimulant dose or changing to a shorter-acting stimulant. Or go with Strattera so you can use a lower dose of stimulant. Or go with guanfacine so you can also use a lower dose of stimulant. Stim...

Consider guanfacine at bedtime.

In my outpatient clinical population (children, teens, and adults) over the past 35 years or so, the most reliable medication to improve stimulant-induced insomnia is mirtazapine 4.75-7.5 mg at bedtime off-label. The mirtazapine will also increase appetite. The trick with mirtazapine is to use a low...

Ask 3-5 times about electronics in the bedroom and sleep hygiene. I suggest parents look at the free app CBT-i coach. Look at dose reduction and/or timing then melatonin low dose. Or clonidine, mirtazapine, trazodone, etc. (as has been shared). Also, look at changing medication to another stimulant ...

I often start with melatonin. Most patients use a dosage that is too high, ranging from 5-15 mg. Going to very low doses is generally better, and my sleep specialist colleagues often have people compound it to 0.25 mg. I usually have patients use sublingual 1.5 mg tablets. These bypass the first-pas...

Timing. Administer the last dose of the stimulant 4-6 hours before the patient’s bedtime. It has worked very well with my adult patients.