Dr. Buchanan: Most child psychiatrists, including myself, consider stimulants first-line. I view alpha-agonists as second-line, or sometimes I use them as augmenters to a stimulant, such as when we see only a partial response from a stimulant or when we are limited in dosing due to side effects. Agents such as Strattera (atomoxetine) and Wellbutrin (bupropion) are generally third-line.