- ADHD Medications
- ADHD medication alone is not enough
- Guidelines for taking ADHD medication
- Dealing with side effects
- Commonly Prescribed ADHD Stimulant Medications
- ADHD update: New data on the risks of medication
- ADHD Medications for Adults and Children: ADD Stimulants, Nonstimulants & More
- ADHD Medications for Adults and Children: Which Are Best?
- How Do Stimulant Medications Treat ADHD?
- How is ADHD Medication Dosed?
- How Does Concerta Work? How Is It Different From Other ADHD Medications?
- Same ADHD Medication, Different Formulations
- Which ADHD Medication is Best?
- ADHD Medications: Methylphenidate
- ADHD Medication: Dextro-Methylphenidate
- ADHD Medication: Dextro-Amphetamine/Modified Amphetamine Mixture
- Attention Deficit Hyperactivity Disorder (ADHD), Inattentive Type in Adults: Management and Treatment
- Parents Guide to ADHD Medications
- Loss of Appetite
- Sleep Problems
- Wear-Off Effects, or ‘Rebound’
- Mood Changes
- What ADHD treatments do you recommend?
- Can the symptoms be managed without medication?
- What medications do you recommend and what are the side effects?
- How effective is medication for ADHD?
- How long will the medication be necessary for treatment?
- What factors will influence the decision to stop medication?
For Parents: Helpful questions about ADHD medication
When deciding whether or not to put your child on medication, Jerome Schultz, Ph.D., ADHD expert, says to first consider the following questions:
- Has my child been helped by non-medication approaches? Self-calming techniques, deep breathing, and yoga can often help children with ADHD.
- Has the school tried to teach my child to be more attentive and less active?
- What is the decision to put my child on medication based on? Is it the result of behavioral observations over time and in different settings, such as in school and at home?
- When is my child at their best? Fishing with an uncle or playing video games? Help the physician understand how pervasive or selective the problem is.
- Does my child have other conditions that can be mistaken for hyperactivity? Children exposed to toxic chemicals or who have undiagnosed learning disabilities and low-level anxiety disorder may demonstrate similar behaviors.
Source: Family Education Network
ADHD medication alone is not enough
Treatment for attention deficit disorder isn’t just about seeing doctors or taking medication. There are many ways to help yourself or your child tackle the challenges of ADHD and lead a calmer, more productive life. With the right tips and tools, you can manage many of the symptoms of your ADHD on your own. Even if you choose to take medication, healthy lifestyle habits and other self-help strategies may enable you to take a lower dose.
Exercise regularly. Exercising is one of the most effective ways to reduce the symptoms of ADHD. Physical activity boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. Try walking, skateboarding, hiking, dancing or playing a favorite sport. Encourage your child to put down the video games and play outside.
Eat a healthy diet. While diet doesn’t cause ADHD, it does have an effect on mood, energy levels, and symptoms. Set regular snack and meal times. Add more omega-3 fatty acids to your diet and make sure you’re getting enough zinc, iron, and magnesium.
Get plenty of sleep. Regular quality sleep can lead to vast improvement in the symptoms of ADHD. Simple changes to daytime habits go a long way toward resting well at night. Have a set bedtime and stick to it. Avoid caffeine later in the day.
Try therapy. ADHD professionals can help you or your child learn new skills to cope with symptoms and change habits that are causing problems. Some therapies focus on managing stress and anger or controlling impulsive behaviors, while others teach you how to manage time, improve organizational skills, and persist toward goals.
Maintain a positive attitude. A positive attitude and common sense are your best assets for treating ADHD. When you are in a good frame of mind, you are more likely to be able to connect with your own needs or your child’s.
Guidelines for taking ADHD medication
If you decide to take medication for ADHD, it’s important to take the drug as directed. Following your doctor and pharmacist’s instructions will help you maximize the effectiveness of medication for ADHD and minimize the side effects and risks. Here are some guidelines for safe use:
Learn about the prescribed medication. Find out everything you can about the ADHD medication you or your child is taking, including potential side effects, how often to take it, special warnings, and other substances that should be avoided, such as over-the-counter cold medication.
Be patient. Finding the right medication and dose is a trial-and-error process. It will take some experimenting, as well as open, honest communication with your doctor.
Start small. It’s always best to start with a low dose and work up from there. The goal is to find the lowest possible dose that relieves you or your child’s symptoms.
Monitor the drug’s effects. Pay close attention to the effect the medication is having on your or your child’s emotions and behavior. Keep track of any side effects and monitor how well the medication is working to reduce symptoms.
Taper off slowly. If you or your child wants to stop taking medication, call the doctor for guidance on gradually decreasing the dose. Abruptly stopping medication can lead to unpleasant withdrawal symptoms such as irritability, fatigue, depression, and headaches.
Talking to your child about ADHD medication
Many kids and teens with ADHD don’t take their medication correctly—or stop taking it without talking to their parents or doctor—so if your child is on ADHD meds, make sure that he or she understands how to take the medication correctly and why following prescription guidelines are important.
Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option. It’s also important to remember that ADHD medication should never have a numbing effect on a child’s energy, curiosity or enthusiasm. A child still needs to behave like a child.
Monitoring ADHD medication’s effects on your child
Here is a list of questions you should ask when your child begins medication therapy, changes dosage, or starts taking a different medication:
- Is the medication having a positive impact on your child’s mood and/or behavior?
- Do you think the dosage or medication is working? Does your child think the dosage or medication is working?
- Does the dose need to be increased or decreased? What was the change in a specific behavior or set of behaviors that caused you to conclude that the medication needed to be evaluated?
- Is your child experiencing any side effects, such as headaches, stomachaches, fatigue or sleeplessness, (or suicidal thoughts if taking Strattera)? What is the likelihood that those side effects will last? (Ask your doctor). Do any lasting side effects (if any) outweigh the medication’s benefits?
- Do you or your child think a medication or dosage level has stopped working?
Source: From Chaos to Calm: Effective Parenting of Challenging Children with ADHD and Other Behavioral Problems, by Janet E. Heininger and Sharon K. Weiss.
Dealing with side effects
Most children and adults taking medication for ADHD will experience at least a few side effects. Sometimes, side effects go away after the first few weeks on the medication. You may also be able to eliminate or reduce unpleasant side effects with a few simple strategies.
Loss of appetite – To deal with reduced appetite, eat healthy snacks throughout the day and push dinner to a later time when the medication has worn off.
Insomnia – If getting to sleep is a problem, try taking the stimulant earlier in the day. If you or your child is taking an extended-release stimulant, you can also try switching to the short-acting form. Also avoid caffeinated beverages, especially in the afternoon or evening.
Stomach upset or headaches – Don’t take the medication on an empty stomach, which can cause nausea, stomach pain, and headaches. Headaches can also be triggered by medication that’s wearing off, so switching to a long-acting drug may help.
Dizziness – First, have you or your child’s blood pressure checked. If it’s normal, you may want to reduce your dose or switch to a long-acting stimulant. Also make sure you’re drinking enough fluids.
Mood changes – If medication is causing irritability, depression, agitation, or other emotional side effects, try lowering the dose. Moodiness may also be caused by the rebound effect, in which case it may help to overlap the doses or switch to an extended-release medication.
If troublesome side effects persist despite your best efforts to manage them, talk to your doctor about adjusting the dose or trying a different drug. Many people respond better to the long-acting or extended release formulations of ADHD medication, which build gradually in the bloodstream and then wear off slowly. This minimizes the ups and downs caused by fluctuating medication levels and causes less of a rebound effect, where symptoms return, often worse than before, as the drug wears off.
Commonly Prescribed ADHD Stimulant Medications
- Childhood ADHD Overview
- Introduction to Attention Deficit Hyperactivity Disorder (ADHD)
- Signs & Symptoms of ADHD
- ADHD Signs and Symptoms: Attention Difficulties
- ADHD Signs and Symptoms: Hyperactivity
- ADHD Signs and Symptoms: Impulsivity
- Are There Different Types of ADHD?
- The Social, Educational, Financial & Occupational Impact of ADHD
- What are the Legal Rights of Caregivers and Their Children with ADHD (USA)?
- A Positive Spin: Is There Anything Good about ADHD?
- Signs of ADHD in Children at Home
- Signs of ADHD in Children at School
- Signs of ADHD in Children in Peer Relationships
- How Do I know if My Child Needs an ADHD Evaluation?
- What Should I Do If I Think My Child Might Have ADHD?
- ADHD Discoveries and Controversies
- ADHD: New and Exciting Brain Research
- ADHD: New and Exciting Brain Research – Part II
- Neurotransmitter Changes with ADHD
- Executive Functions
- Neurodiversity: Is ADHD a True Mental Disorder?
- ADHD Statistics
- Cultural and Gender Differences in Prevalence Rates
- Should Children with ADHD Be Medicated?
- New and Promising Areas of Research
- Causes of ADHD in Children
- Causes of ADHD – Genetics
- Do Video Games and Media Exposure Cause ADHD?
- Do Sugar and Diet Cause ADHD?
- ADHD or Another Condition?
- Is It ADHD, or Something Else?
- ADHD and Co-Occurring Disorders
- ADHD and Depression, Anxiety Disorders or Bipolar Disorder
- ADHD and Learning Disorders, Autism and More
- Diagnosis of ADHD in Children
- Who Can Diagnose ADHD?
- How Does ADHD Multi-Source Assessment Work?
- Assessment Instruments: Behavioral Checklists
- Assessment Instruments: Intelligence Tests
- Assessment Instruments: Achievement Tests (or Academic Tests)
- Assessment Instruments: Tests of Attention
- Assessment Instruments: Memory and Other Common Tests
- Step 2: Clinical Interviews
- Step 3: Physical Exam and Medical History
- ADHD Treatment in Children
- Multimodal ADHD Treatment Approach
- ADHD Medications
- Treating ADHD with Stimulant Drugs
- Commonly Prescribed ADHD Stimulant Medications
- Treating ADHD with Non-Stimulant Drugs
- Risks of ADHD Medication
- Risks of ADHD Medications – Part II
- Benefits of ADHD Medication
- Side Effects of ADHD Medications
- Medication Decisions and Medication Management
- How Long Should ADHD Medication Treatment Last
- Psycho-Education about ADHD and Its Management
- Family Therapy
- Individual and Cognitive Behavioral Psychotherapy for the Child with ADHD
- Skills Training
- Social Skills Training and Coaching
- Alternative ADHD treatment: What Does NOT Work?
- Family and Personal Supports
- Effective Disciplinary Techniques
- Learn about Resources and Be Proactive
- Manage Stress, Self-Regulation & Provide Order
- Develop Routines, Organization and Expectations
- Communicate and Collaborate with Schools
- Express Confidence in Your Child’s Abilities
- Help Children Improve Social Skills and Peer Relationships
- Avoid Homework Battles and Monitor Medication
- I Think I have ADHD. What should I do?
- I Think I Have ADHD – Part II
- Famous People with ADHD
- Adult ADHD Overview
- What is Adult ADHD?
- Living with ADHD
- Signs and Symptoms of Adult ADHD
- Are There Different Types of ADHD?
- Prognosis and Long-term Outcomes
- Problems Associated with Adult ADHD
- ADHD Workplace Challenges and Solutions
- Legal, Financial and Relationship Challenges of Adult ADHD
- What Causes ADHD?
- Diagnosis of Adult ADHD
- How is Adult ADHD Diagnosed?
- Diagnostic Challenge 1: Looking into the Past
- Diagnostic Challenge 2: ADHD versus Similar Disorders
- Diagnostic Challenge 2 – Part II
- Diagnostic Challenge 3: ADHD Symptoms
- Diagnostic Challenge 3 – Part II
- Diagnostic Challenge 4: A Concealed Disorder
- Specialized Tests and Tools
- Adult ADHD Treatment
- ADHD Medication Treatment
- Stimulant and Non-Stimulant Drugs for Adult ADHD
- Medication Timing, Dosage, Monitoring, and Duration of Treatment
- Weighing the Risks and Benefits of Adult ADHD Medications
- Psychotherapy for ADHD
- Coaching/Supported Employment for Adult ADHD
- Social Skills Training for Adult ADHD
- Psycho-Education and Cognitive Behavioral Therapy (CBT)
- ADHD Resources and References
- ADHD References
- Additional Resources & Reading List
- Childhood ADHD Overview
- ADHD in Childhood May Mean Financial Struggles Later
- Young Adults With ADHD More Vulnerable to Nicotine
- Health Tip: Managing ADHD in Adults
- Could Fish Oil Be an ADHD Remedy for Some Kids?
- ADHD Rates Doubled Among U.S. Adults Over 10 Years
- Raising a Child With ADHD Can Test a Parent
- Pregnancy Much More Likely for Teen Girls With ADHD
- Pediatric Group Issues Updated ADHD Guidelines
- More U.S. Kids Being Diagnosed With Autism, ADHD
- Youngest in Classroom Diagnosed More Often With ADHD, Other Problems
- 10 more
- Why ADHD Might Raise the Risk of Early Death
- ADHD Meds May Alter Boys’ Brains
- Athletes With ADHD May Need More Time to Recover From Concussion: Study
- ADHD Meds Help Keep Kids Out of Trouble
- Crash Risk Much Higher for Teen Drivers With ADHD
- Does Diet Affect a Child’s ADHD?
- Good Sleep a Must for Teens With ADHD
- Risk of Psychosis Varies With ADHD Meds, But Still Small: Study
- ADHD Meds Safe With Epilepsy, Study Finds
- Jasper/Goldberg Adult ADHD Questionnaire
- How to Select the Best School Accommodations for Your Child with ADHD
- How to Manage ADHD and Anxiety
- What You Need to Know about Students with ADHD and Anxiety
- ADHD and Eating
- Tourette Syndrome and ADHD
- Nutrition in Support of ADHD Treatment
- Behavioral Therapy: What it is and finding a therapist
- Project-Based Learning and ADHD
- Conditions May Mimic ADHD
- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part I
- 91 more
- Treating ADHD in the African American Community
- How to Build Self-Motivation in Teens with ADHD
- Goal Setting and Keeping for the ADHD Brain
- Neurofeedback Treatment for ADHD
- ADHD in Preschoolers: What to Look For and How to Help
- FYI on ADHD Evaluations
- Teaching Grit, Perseverance and Frustration Tolerance to Students with ADHD
- Does my Child Have ADHD?
- How to Start Eating Well When You Have ADHD
- 5 Solutions for Common ADHD Social Struggles
- Is My High School Student Ready for College? (And Is My College Student Ready to Go Back?)
- Understanding and Applying the Science of Time Management
- Improve Homework Time with Strategies That Work For ADHD
- Student Voices: What Really Matters to Young Adults With Learning and Attention Issues
- 5 Ways Nutrition can Impact ADHD Symptoms
- 3 Tips for Adjusting to a New Diagnosis of ADHD
- Creating the Best Learning Environment for Students with ADHD
- ADHD & Executive Functioning
- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part II
- The Choice is in the Details: Medication Options for ADHD
- Couples with ADHD: Creating Caring Connection amid the Chaos
- Disclosure and Workplace Accommodations for Individuals With ADHD
- A Summer At Camp
- Self-Advocacy Tips For Teens With ADHD
- ADHD: Signs, Symptoms, Research
- ADHD & Risk of Adult Drug Use
- Health and Life Expectancy in ADHD
- Focus on ADHD
- Pediatrics: ADHD and Food Allergies
- ADHD Treatment
- ADHD: It’s a Family Affair
- Does Your Child Have ADHD?
- ADHD in Children
- Living with ADHD
- Rise in ADHD Cases in Children
- Why is Dating Difficult When You Have ADHD
- Video Games, Screens, and ADHD A Potent Mix
- Attention Deficit Hyperactivity Disorder
- Ask the Expert Educator Edition: ADHD & Executive Functioning
- Ask the Expert – Academic Evaluations – What Parents Need to Know
- ADHD and Sibling Relationships
- Medication Treatment for ADHD
- Using Time Out
- Treating Childhood ADHD
- ADHD-friendly Summer Family FUNdamentals
- Preparing Older Teens for the Road Ahead
- Tips for Teachers: Tailoring homework to make a difference
- Your Active Preschooler: Could it be ADHD?
- A Pattern of Struggles: ADHD and the Older Adult
- Tips for Teachers: Creating a positive dialogue with parents of students with ADHD
- Helping Parents & Kids Understand the Social & Emotional Aspects of ADHD
- Social and Emotional Concerns of Children with ADHD: Strategies to Help
- Holiday Gifts for Children with ADHD
- Behavior Management and Combined Treatment for Children with ADHD
- Setting Realistic School Expectations for Students with ADHD
- On Their Own: Helping College Students with ADHD
- Children’s Communication Challenges: Is it Attention, Language or Both?
- Out-of-School: Parenting During the Summer
- ADHD in the Workplace: Finding Success
- Emotions and Motivation in ADHD
- The Role of Medication in Managing Children’s ADHD Symptoms
- Top Tips for Combating Stigma and Addressing Myths about ADHD
- Facts and Myths about ADHD
- What To Do If Your Child Has ADHD?
- How Common is ADHD?
- Children, Meds, and Heart Safety: A Tale of ADHD and Public Health
- ADHD & Your Childs Transition to College
- Your Teen with ADHD: Challenges and Strategies for Success
- Ask the Expert – No more homework battles
- A Frontline to ADHD
- Understanding Girls with ADHD
- What is ADHD?
- What To Do When Your Child With ADHD is Bullied
- Stop the Chaos! Tips for Creating a Peaceful Household When Mom has ADHD
- Is It ADHD?
- Ask the Expert – What else can I do? Complementary approaches to ADHD treatment
- All in a row: Getting your kids with ADHD organized
- Your Student With ADHD Was Admitted to College, Now what?
- Evidence-based treatment for ADHD in young children
- Home life when Mom or Dad has ADHD: Succeeding with your family
- How does technology affect ADHD?
- Diagnosing ADHD
- Helping Your Child Successfully Handle Change
- Recognizing challenging behaviors in young children: Could it be ADHD?
- Classroom Managment Supports for ADHD Behaviors in Preschool Settings
- Getting through to your teenager with ADHD
- What Everyone Should Know about ADHD
- Make Learning Exciting: Apps for Executive Functioning
- Teenagers, ADHD, and Substance Abuse
- Past Procrastination — Get Your Kids Organized, Focused and Motivated
- Ask the Expert: Late, Lost, and Unprepared: How to Help Your Child with Executive Functioning
- An Interview with Ari Tuckman, PsyD, MBA, on Adult ADHD
ADHD update: New data on the risks of medication
Published: October, 2006
Medications — chiefly the stimulants dextroamphetamine and methylphenidate — are the only proven treatment for attention deficit hyperactivity disorder (ADHD), with its symptoms of distractibility, impulsiveness, and hyperactivity. But the benefits of stimulants last only as long as patients continue to take them, and worries about the risks of long-term use are again in the news.
Blood pressure and heart problems. Stimulants raise blood pressure and heart rate. New data are fueling a debate about how dangerous this is for people who take the drugs for extended periods. In 2005 Health Canada, the Canadian equivalent of the FDA, removed Adderall XR (an extended-release form of dextroamphetamine) from the market, citing a suspicious pattern of 20 sudden deaths and 12 strokes in children and adults taking the drug. The ban was lifted when many of these patients proved to have structural heart defects.
This spring an FDA panel reported on a study of physicians’ reports on ADHD medications recorded in its Adverse Events Reporting System database. More than 300 people taking the medications died suddenly. Only 25 of these deaths appeared to be drug-related, and autopsies indicated pre-existing heart abnormalities in some of these cases. There were also 26 incidents of apparently drug-related symptoms such as chest pain, heart attacks, strokes, and arrhythmias. In a close vote, the panel members recommended the strongest possible action short of banning the drugs, a so-called black box warning of cardiovascular risk on prescription labels. They also unanimously recommended improved information sheets for physicians, patients, and families.
The FDA records were not easy to interpret. On the one hand, it’s estimated that fewer than 10% of adverse drug effects are actually reported. On the other hand, the rate of sudden cardiac death in the survey was much lower than the average among children of the same age in the general population. After further analysis, a second FDA panel canceled the black box warning but agreed to strengthen present warnings about prescribing these medications to anyone with high blood pressure or heart defects.
Meanwhile, the Medicines and Healthcare Products Regulatory Agency, the British equivalent of the FDA, noted seizures and heart rate irregularities in a few people taking atomoxetine (Strattera), a new ADHD drug that is not a stimulant. The overwhelming majority of them had a prior history of seizures (which the drug did seem to exacerbate). Heart rate irregularities were less common and often associated with the use of antidepressants that interfered with the breakdown of atomoxetine. The British agency required updating of the drug’s label.
The bottom line is that ADHD drugs are not likely to cause cardiovascular problems in anyone who does not already have underlying cardiac risk. But more such people are now using the drugs, because of the explosive growth in adult prescriptions. One estimate is that 1.5 million adults, 10% of them over age 50, now take stimulants for ADHD. Careful screening and monitoring make sense.
Growth suppression. Many children start taking ADHD medications young and stay on the drugs for years, so the effect on growth is a persisting concern. Three studies offer conflicting evidence. In the first study, 178 children ages 6–13 taking Concerta (a sustained-release form of methylphenidate) were followed for nearly two years. Their height and weight were average at the start; at the end, they were slightly shorter and lighter than average, but the difference could have been due to chance.
In a second study, 79 children ages 6–12 at the outset, also taking Concerta, were followed for up to five years. The results varied by age, sex, and dose, with overall small but statistically significant differences from the average in weight (about 3 pounds for a nine-year-old boy) and height (a little under an inch for a 13-year-old boy).
In a third, larger study with a broader focus, children ages 7–9 were followed for two years. At the end, those who had continuously taken ADHD medication during that time were on average half an inch shorter and 8 pounds lighter than those not taking the medication. To clarify the practical significance of this effect, researchers will have to do studies taking into account the adolescent growth spurt.
Abuse and diversion. Investigators at the Centers for Disease Control and Prevention examined the records of 64 hospital emergency departments and found 188 visits involving ADHD medications from August 2003 to December 2005. The overwhelming majority of the patients were children, and in 60% of cases the cause was intentional ingestion or an overdose, usually of a medication prescribed for someone else. About 15% of the patients had cardiovascular symptoms such as chest pain and high blood pressure; other symptoms included stomach pain, muscle weakness, and rashes.
The stimulants used to treat ADHD have some potential for abuse, because crushing pills and snorting (snuffing) them can produce a cocaine-like high. Several studies indicate that nearly 10% of students in grades 7–12 have used nonprescribed stimulants; that as many as a third of young ADHD patients have been asked to sell or give away their medications; and that 7%–15% have done so. A 10-year study suggested that 11% of adolescent and adult ADHD patients had sold the drugs at some time; 22% had taken more than prescribed; and 10% had used the drugs to get high. Nearly a third had used alcohol or other drugs while taking the ADHD medication, but only 5% had experienced bad side effects as a result.
More than 80% of the abusers already had a diagnosis of conduct disorder or substance abuse, so they were at high risk for selling or using illicit drugs of any kind. The overwhelming majority of abusers were taking immediate-release preparations. These are increasingly being supplanted by extended-release formulas (and a skin patch), which are absorbed so gradually that they don’t cause a euphoric sensation and are therefore much less susceptible to misuse.
So, over all, new findings do not seriously challenge the consensus that most people who are properly diagnosed with ADHD will decide that the benefits of stimulant medications outweigh the risks.
Children And Adults with Attention Deficit/Hyperactivity Disorder800-233-4050 (toll free)www.chadd.org
This support and educational organization of parents of children with ADHD sponsors lectures, maintains support groups, publishes information, and refers patients for treatment.
National Institute of Mental Health www.nimh.nih.gov/healthinformation/adhdmenu.cfm
Provides information on symptoms, publications, research, treatment, clinical trials, and how to get services.
Charach A, et al. “Stimulant Treatment Over 5 Years: Effects on Growth,” Journal of the American Academy of Child and Adolescent Psychiatry (April 2006), Vol. 45, No. 4, pp. 415–21.
MTA Cooperative Group. “National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: 24-Month Outcomes of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder,” Pediatrics (April 2004), Vol. 113, No. 4, pp. 754–61.
MTA Cooperative Group. “National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: Changes in Effectiveness and Growth After the End of Treatment,” Pediatrics (April 2004), Vol. 113, No. 4, pp. 762–69.
Nissen SE. “ADHD Drugs and Cardiovascular Risk,” New England Journal of Medicine (April 6, 2006), Vol. 354, No. 14, pp. 1445–48.
Spencer TJ, et al. “Does Prolonged Therapy with a Long-Acting Stimulant Suppress Growth in Children with ADHD?” Journal of the American Academy of Child and Adolescent Psychiatry (May 2006), Vol. 45, No. 5, pp. 527–37.
Wilens TE, et al. “Characteristics of Adolescents and Young Adults with ADHD Who Divert or Misuse Their Prescribed Medications,” Journal of the American Academy of Child and Adolescent Psychiatry (April 2006), Vol. 45, No. 4, pp. 408–14.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Hands up if any of these things describes your kids, you as a kid, or kids you know: inability to wait for a turn; temper tantrums; fidgeting; inability to finish chores; being too loud; being too quiet. Congratulations! The kid in question might have attention deficit hyperactivity disorder and he (and it’s a he twice as often as it’s a she) can take medication to “normalize” him.
ADHD drugs are a $13 billion industry in the United states, and ADHD is now the second most-common childhood diagnosis. But, even though the long term effects of these amphetamines on the childhood brain are unknown, the numbers will probably continue to rise: The American Psychiatric Association, which has recently expanded the criteria for ADHD diagnosis, receives 20 to 30 percent of its funding from pharmaceutical companies.
Who are not necessarily acting your best interests: Last year, Shire Pharmaceuticals, which makes Adderall, settled with the Department of Justice for more than $50 million based, in part, on allegations that it marketed its ADHD based on unsupported claims that it would prevent, say, poor academic performance. This video gives you a rundown of the situation (but if it makes you mad, don’t throw a tantrum or someone will come medicate you).
ADHD Medications for Adults and Children: ADD Stimulants, Nonstimulants & More
ADHD Medications for Adults and Children: Which Are Best?
I recently saw a child who, after receiving extensive evaluation, was diagnosed with inattentive attention deficit hyperactivity disorder (ADHD). In talking with his mother about starting him on the ADHD stimulant medication methylphenidate, I realized that the number of medications for adhd was confusing. Let’s set the record straight about the process of selecting the best ADHD medication for you.
The ADHD medications prescribed to both children and adults are categorized as stimulant — amphetamine or methylphenidate — or non-stimulant. Stimulants are considered the treatment of choice for ADHD. Non-stimulants are prescribed to patients who don’t tolerate or see benefits from stimulants. Certain non-stimulants, particularly alpha agonists, are prescribed with medication to treat symptoms that stimulants do not alleviate. The most popular ADHD medications among ADDitude readers include (in alphabetical order):
- Adderall XR (amphetamine)
- Concerta (methylphenidate)
- Dexedrine (amphetamine)
- Evekeo (amphetamine)
- Focalin XR (dexmethylphenidate)
- Quillivant XR (methylphenidate)
- Ritalin (methylphenidate)
- Strattera (atomoxetine hydrochloride)
- Vyvanse (lisdexamfetamine dimesylate)
Many parents and adults are similarly confused by these and other treatment choices for ADHD. Our ADHD medication chart can help you learn the facts about both stimulants and non-stimulants in the treatment of ADHD. The Food and Drug Administration (FDA) requires that a medication be given a different name according to its form (capsule, tablet, liquid, patch) or release mechanism (released immediately or over an extended period of time).1 Here’s an example: The ADHD medication Ritalin is a tablet that is released immediately into the bloodstream and works for four hours. Ritalin LA, on the other hand, is a capsule that releases over a longer period of time and works for eight hours. Different names, even though both contain the same medicine — methylphenidate.
How Do Stimulant Medications Treat ADHD?
ADHD is a neurologically based disorder, resulting from the deficiency of a neurotransmitter, or a group of neurotransmitters, in specific areas of the brain. Neurotransmitters are chemicals that transmit signals between nerve cells by bridging the synapse (or gap) between them.2
The key neurotransmitter involved is norepinephrine, along with its building blocks, dopa and dopamine. In theory, the primary medications used to treat ADHD stimulate specific cells within the brain to produce more of the deficient neurotransmitter. That’s why these medications are called stimulants — though it’s unknown exactly how they work to relieve ADHD symptoms.
The two main classes of stimulant medications, methylphenidate and dextro-amphetamine — both are generic names — have been used since the 1930s.3 All brand-name stimulants are variations of these two medications. The ADHD medication Adderall is a modification of dextro-amphetamine, for instance, while methylphenidate comes as an immediate-release tablet, a chewable tablet, a liquid, a skin patch, an intermediate-acting (extended-release) tablet, a long-acting (extended-release) capsule, and a long-acting (extended-release) tablet. Each variation has its own name, but the medicine that treats symptoms is the same — methylphenidate.
How is ADHD Medication Dosed?
Parents of children with ADHD ask me: “My child was on Adderall 10 mg, and my doctor changed her prescription to Vyvanse 60 mg. Why was the dose increased?” The reasons for the numbers have to do with target dose and release mechanism.
Target dose: Each product releases a specific amount of medication into the blood over a given period of time. The FDA requires that the number value for each product represent the total amount of the medication in the tablet/liquid/capsule/patch, not the amount in the blood at any one time. Thus, if the medication, let’s say methylphenidate, is in the form of a four-hour tablet, and it releases 5 mg over that time, it is called methylphenidate 5 mg. A capsule of Adderall that releases 10 mg immediately and 10 mg four hours later is called Adderall XR 20. The number is not based on the amount released at any one time, but on the total amount of the medication in the capsule.
Release mechanism: This indicates the length of time a medication will remain available and active. Stimulants come in a variety of forms — tablet, capsule, liquid, skin patch — and release medication in an hour, four hours, or over eight or 12 hours.
How Does Concerta Work? How Is It Different From Other ADHD Medications?
Many people are confused about the ADHD medication Concerta. Designed to last 12 hours, Concerta has a “sponge” on the bottom of the capsule, medication on top, and a tiny hole above the medication. As the capsule passes through the gastrointestinal tract and absorbs moisture, the sponge expands and pushes the medication out of the hole.
The number value assigned to each dose is confusing. Take Concerta 18 mg. If the goal is to release 5 mg consistently every four hours over a 12-hour period, then there needs to be 15 mg in the capsule. However, it takes time for the sponge to become moist enough to start to expand. So an initial release of medication is needed until the sponge starts working. Researchers figured out that it should be 3 mg. Thus, to release 5 mg over 12 hours, one needs the initial 3 mg, plus 5 mg every four hours during the 12 hours. The total amount of medication is 18 mg. That’s why the medication is called Concerta 18.
Same ADHD Medication, Different Formulations
Medications such as methylphenidate and dextro-amphetamine also come in liquid forms. The patient information sheet inside the medication’s box or packaging states how much medication is in each unit of liquid; for example, 5 mg per 5 ml of liquid. Another methylphenidate product — Daytrana4 — is a patch that releases medication through the skin and into the bloodstream. Daytrana 30 mg contains about 30 mg of methylphenidate, and releases about 3.3 mg of it per hour.
Which ADHD Medication is Best?
In short, there’s no way to know which stimulant medication will work “best” for any one person’s ADHD. It’s often related to your history, your genetics, and your or your child’s unique metabolism. The next time a doctor rattles off medications and dosages that might be appropriate for you or your child, consult this comprehensive list.
ADHD Medications: Methylphenidate
- Generic: tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages
- Adhansia XR: brand name; capsule; extended release; lasts about 16 hours; comes in 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, and 85 mg dosages
- Aptensio XR: brand name; capsule; immediate and extended release; lasts 12 hours; comes in 10, 15, 20, 25, 30, 40, 50, and 60mg dosages
- Concerta: brand name; tablet; lasts about 12 hours; comes in 18, 27, 36, 54 mg dosages
- Cotempla XR-ODT: brand name; extended release orally disintegrating table; comes in 8.6mg, 17.3mg, and 25.9mg
- Daytrana: brand name; skin patch; lasts about eight hours; comes in 10, 15, 20, 30 mg dosages
- Jornay PM: brand name; delayed release extended release capsule; comes in 20mg, 40mg, 60mg, 80mg, and 100mg
- Metadate CD: brand name; capsule; lasts eight hours; comes in 10, 20, 30, 40, 50, 60 mg dosages
- Metadate ER: brand name; tablet; lasts eight hours; comes in 10, 20 mg dosages
- Methylin: brand name; liquid and chewable tablets; immediate release; lasts four hours; tablets come in 2.5, 5, 10 mg dosages, liquid in 5 mg/tsp and 10mg/tsp dosages
- QuilliChew ER: brand name; chewable tablet; extended release; lasts eight hours; comes in 20, 30, and 40 mg dosages
- Quillivant XR: brand name; liquid; extended release; lasts 12 hours; dosages range from 20 to 60 mg
- Ritalin: brand name; tablet; immediate release; lasts about four hours; comes in 5, 10, 15 mg dosages
- Ritalin LA: brand name; capsule; lasts about eight hours; comes in 10, 20, 30, 40 mg dosages
- Ritalin SR: brand name; tablet; lasts about eight hours; comes in 20 mg dosage
ADHD Medication: Dextro-Methylphenidate
- Focalin: brand name; tablet; lasts four hours; immediate release; comes in 2.5, 5, 10 mg dosages
- Focalin XR: brand name; capsule; lasts eight hours; immediate release followed by second delayed release; comes in 5, 10, 15, 20, 30, 40 mg dosages
ADHD Medication: Dextro-Amphetamine/Modified Amphetamine Mixture
Larry Silver, M.D., is a member of ADDitude’s ADHD Medical Review Panel.
Updated on January 14, 2020
Follow me at @ellenbraaten, the MGH Clay Center
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders, with prevalence rates around 3%-4%. Medication is frequently used to treat the symptoms of inattention, impulsivity, and hyperactivity that are associated with the disorder. It’s a developmental disorder, meaning that the symptoms start in childhood, before the age of 12. The symptoms can impair functioning in school and at home, and interfere with forming and keeping friendships.
I’m a psychologist and I don’t prescribe medication, but despite that fact, parents often ask me, “Should my child with ADHD be on medication?” followed by, “What are the downsides of medication?” and then frequently follow up with, “Aren’t there too many kids on medication anyway?” A study published last fall in BMJ can help parents and professionals with answers to these questions in terms of the drug methylphenidate, in particular.
Methylphenidate is the most commonly prescribed drug for ADHD worldwide. It’s known by a number of brand names, including Ritalin, Concerta, Metadate, Daytrana, and Quillivant. Although it has been used for over 50 years to treat ADHD — and studies have found it to be effective in decreasing the symptoms of inattention, impulsivity, and hyperactivity — there had been no comprehensive, systematic reviews of the benefits and risks of this drug until this study.
What we’ve learned about methylphenidate
For the study, the investigators reviewed hundreds of papers that had examined the effects of methylphenidate for ADHD. Their analysis found that methylphenidate did improve children’s performance in the classroom. In other words, teachers reported fewer symptoms of ADHD and better general behavior when kids with ADHD were taking the medication. In addition, parents reported a better quality of life for the family when their children were taking medication.
On the other hand, there was some evidence that methylphenidate comes with the risk of side effects, including sleep problems and decreased appetite. These side effects are considered “non-serious adverse effects.” However, if you’re a parent of a child who isn’t sleeping or eating, these may seem quite serious. The good news is that there was no evidence that methylphenidate increases serious side effects, which would include life-threatening problems — that is, something that would require a hospital stay or result in a life-long condition.
What should parents do?
So what does this mean for parents trying to decide whether their child should take ADHD medication? First, they don’t need to worry about whether taking the most widely prescribed medication — methylphenidate — will cause serious, long-term problems. It most likely will not. Second, because a fairly large percentage of kids who take methylphenidate (about 25%, based on this study) may experience minor and short-lived problems such as difficulty with appetite and sleep, parents should be prepared to see these effects in their children. Knowing that issues such as these might be a problem, and that these issues may improve as a child adjusts to the medication, can help parents anticipate possible solutions — which can include, for example, having a big breakfast before taking the medication or lowering the dose if sleep is an issue. These are all things that can be discussed with a child’s pediatrician, and there are ways to cope with these issues once they are identified. Finally, parents can be comforted by the fact that these medications can improve a family’s quality of life at home, a child’s general behavior at school, and result in fewer problems with attention, impulsivity, and hyperactivity.
ADHD medication: The bigger picture
This study doesn’t answer the question of whether there are too many children on medication. Interestingly (and often surprisingly, for many people), other studies have shown that at least one-third and up to one-half of children with significant developmental and psychological problems go untreated. That’s a lot of kids who need help, either through some sort of therapy, educational support, or (for some) medication. This study also only addresses one medication, although it is the one that is most popularly prescribed.
Deciding what treatment option to use when you have a child with ADHD isn’t easy. Medication isn’t the only option, as there are data that show some behavioral treatments that can help children with ADHD learn different skills are also effective. In fact, recent studies indicate that a combination approach might be best. In other words, medication can help kids to get more out of non-medication treatments such as therapy and school supports. When prescribed correctly by a medical doctor who understands and commonly treats these issues, the downsides of medication with methylphenidate probably do not outweigh the positives in most cases.
Attention Deficit Hyperactivity Disorder (ADHD), Inattentive Type in Adults: Management and Treatment
How is attention deficit hyperactivity disorder (ADHD), inattentive type, in adults treated?
Although there is no cure for the disorder, it can be successfully treated. There are several different approaches for treating adults, but generally some combination of medication and behavioral therapy yields the best results.
Medications. Prescription drugs that are used to treat ADHD in children usually are effective for most adults with the predominantly inattentive form of ADHD. However, the dosage and frequency of medications may have to be adjusted early during the course of treatment. It is important to match the needs of the person with ADHD with the characteristics of the drug.
The major classes of prescription medications that are prescribed for ADHD are psychostimulants, antidepressants, and nonstimulant drugs. These treatments affect the neurotransmitters that send signals to brain cells.
- Psychostimulants are the medications of choice in treating ADHD. The two types that are most commonly used are amphetamine and methylphenidate. Mixed amphetamine salts are marketed under the brand name Adderall®. Methylphenidate is sold under the brand names Ritalin®, Concerta®, Metadate® and others. Immediate release, sustained released and extended release forms of amphetamine and methylphenidate are available. The dosage and frequency of these medications may have to be adjusted to maximize their effectiveness. Extended-release formulations are recommended over immediate-release formulations.
In certain cases, if psychostimulants are not effective or the person has a co-existing psychological disorder that may be affected by stimulant treatment, other medications might be prescribed.
- Antidepressants: Drugs such as tricyclic antidepressants, monoamine oxidase inhibitors, bupuprion (Wellbutrin®) and venlafaxine (Effexor®) increase norepinephrine levels in the brain and have a positive effect on the symptoms of ADHD. These drugs are not approved by the FDA for this indication, although they are used off-label.
- Nonstimulants: These medications may be required in cases where a patient does not respond to stimulants or has an adverse reaction to them. They may also be used for people with co-existing psychiatric conditions. Atomoxetine (Strattera®) was the first nonstimulant drug approved by the U.S. Food and Drug Administration to treat ADHD in adults. Guanfacine (Intuniv®, Tenex®) is another example of a nonstimulant medication.
Behavior modification or other forms of therapy. Various approaches may be used to treat adults with inattention problems. Cognitive-behavioral therapy (CBT) helps patients identify problem behaviors and create and implement strategies to self-regulate (control your behavior, emotions and thoughts), change behavior and achieve goals. With CBT, patients identify automatic or irrational thoughts that may result in negative behavior and replace them with positive thoughts and behaviors. Acceptance Commitment Therapy is another form of therapy designed especially to empower individuals to pursue personal values and engage in behavior consistent with their values as opposed to trying to change the individual. Other programs have been developed to enhance self-management, but these are not yet widely available. Group therapy may be effective for adults with ADHD, especially for women.
Coaching is a relatively new approach that has become more popular over the past few years. Coaches help people with ADHD handle the challenges of daily life by providing feedback, recommendations and encouragement, and directing the individual to attend to their own solutions to problems. They also offer practical solutions to address certain issues–such as time management and organization–and help their clients achieve goals.
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Parents Guide to ADHD Medications
Loss of Appetite
This is the most common side effect of these medications. The loss of appetite happens when the meds are effective and wears off just like the benefits of the medication. Kids may be very hungry when the meds wear off and if they haven’t eaten they may also be irritable and grouchy. This is typically a manageable problem, but we suggest that this issue be discussed with the doctor who prescribes the medication.
Kids who take this medication can experience troubles falling asleep. This is usually a mild change and it tends to occur more in kids who are younger and who might have had issues with falling asleep before they started the medication.
Many things can interfere with falling asleep. So it also is important to figure out whether any of those things are present (worry about school or friends, excess screen time before bed, etc.) when you’re evaluating the effects of medication.
Problems falling asleep can sometimes get better over time and may be helped by changing either the time or type of the medication that is given. For example, if a child is taking a short-acting formula, it may mean that he is taking a second or third dose too late in the day, so it hasn’t worn off by bedtime.
In spite of concerns that have been voiced regarding growth and stimulants, a recent well-done clinical study showed that neither ADHD nor treatment with stimulants was associated in a change in how fast kids grow during the maximum growth period or in final adult height. Combined with other studies, it seems clear that stimulant treatment has little to no impact on growth.
Wear-Off Effects, or ‘Rebound’
A small minority of children experience behavioral changes as their ADHD medication wears off, typically at the end of the school day. Some parents call it “rebound” but the term is a bit misleading. They can seem more irritable or emotional, but it is usually mild. It is important to make sure that they aren’t simply hungry from having missed the midday meal. This may be connected to the medication level dropping, and strategies that create a more gradual decrease in the medication level may help take it away, such as adding a smaller dose a half hour before the medication wears off.
About 10% of kids with ADHD will have tics whether or not they take medications, so there are a lot of kids who have both. Tics usually start between 6 and 8 years of age, which is often when kids first start taking a medication for ADHD. Tics also come and go over time. The best we know from a series of studies is that stimulants don’t cause tics, and can be used to treat children with both ADHD and tics. But this should be monitored during treatment
If you child has tics or develops tics during treatment, you could discuss trying a non-stimulant medication, which affects the brain in a different way.
When a stimulant dose is too high for a child he may begin to look sedated or zombie-like, or tearful and irritable. If this happens the prescription should be adjusted until the right dose is found: one in which the child gets the benefits of the medication with the least possible side effects.
But there is a small subset of kids with ADHD who seem to get moody and irritable when they take stimulant medications, even if they are taking the best possible dose. It usually happens right away, as soon as they start taking the medication, and goes away immediately when they stop taking it.
If this happens with your child, it may help to switch to a different stimulant, since some kids react differently to those based on methylphenidate and those based on amphetamine. If that doesn’t work, a non-stimulant medication is a possibility.
Of course it’s important to keep in mind that kids who have ADHD can also develop depression. In fact they are at a higher risk for developing major depressive disorder than other kids. The good news is that kids can be safely treated for both disorders at the same time, though we don’t recommend treating mood problems that are a side effect of stimulant meds with another medication.
When a child is diagnosed with attention deficit hyperactivity disorder (ADHD), parents are faced with the decision of whether to treat the disorder with medication. Parents often worry that medication will change their child’s personality or become habit-forming, or they might feel overwhelmed by the number of different medications on the market.
Medication cannot cure ADHD, but it can improve overall functioning at home and school. Researchers have found that stimulant medication is typically the most effective way to treat ADHD, both alone and in combination with therapy.1 Stimulants help increase levels of neurochemicals in the part of the brain which controls attention, focus, planning, and organization. When monitored and administered correctly by a doctor, stimulants can effectively reduce symptoms of hyperactivity and inattention in children and teens with ADHD.
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What’s the difference between stimulants used to treat ADHD?
There are two major classes of stimulants: amphetamines and methylphenidate, both of which have been in use for decades. Amphetamines include medications such as Adderall, Dexedrine, and Vyvanse. Methylphenidate medications include Ritalin, Concerta, Daytrana, Focalin, Metadate, and Methylin, among others.2
ADHD medications like Ritalin were originally designed to only last a few hours. Now some stimulants like Concerta come in an ascending dose, with compartments within the medication that release at different times after swallowing. These extended release versions can last for up to 12 hours. Sometimes capsules may be hard for young children to swallow, so other brands offer the medication in bead form. Parents can open the capsule and sprinkle it into food for the child to easily ingest. Daytrana is the only ADHD medication that comes in a transdermal patch, which can be stuck to the hip for quick absorption.3
How likely is it that my child will respond to stimulant medication?
There’s an 80% chance that your child will respond to stimulant therapy. If they do, there’s a 50% chance that both methylphenidates and amphetamines will work, and a 25% chance that they’ll respond to only methylphenidates or amphetamines.4 If a medication doesn’t prove effective, talk to your doctor about adjusting the dosage or trying a different class of stimulant. They may also recommend behavior therapy in conjunction with medication or taking a non-stimulant medication.
Which non-stimulant medications have been approved to treat ADHD in children?
Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine) are the three non-stimulant medications approved to treat children with ADHD.5 These medications are typically prescribed after stimulant medications fail to effectively treat symptoms, and sometimes they are prescribed conjointly with stimulants to treat symptoms. Though they have not been approved by the FDA to treat ADHD, sometimes antidepressants are prescribed “off-label” by doctors to treat ADHD symptoms. However, the effectiveness of these medications in treating the disorder among children or adults has not yet been established, and children and teens are at increased risk for suicidal thoughts when taking antidepressants.6
How old does my child have to be to receive ADHD medications?
The American Academy of Pediatrics recommends trying behavior treatment for preschool and kindergarten-aged children first and then medication only as needed. Most medications have only been FDA-approved from children ages 6 and older, but sometimes physicians will prescribe a very low dose of a methylphenidate medication for children younger than 6.7
How long does it take for ADHD medication to start working?
Stimulants are designed to begin working immediately, often within half an hour. Non-stimulants, however, can take several weeks before the drug will reach its full effect. It’s important to talk to your child’s doctor before you discontinue use, as your child can experience withdrawal symptoms.
Will taking medication alter my child’s personality?
If you notice a shift in your child’s personality, then it’s possible that they are on too high of a dose. When prescribed and administered properly, ADHD medication should help your child concentrate and be less hyperactive, but it will not change their personality. Young children may not notice anything different in their behavior, but teens may comment that people view them as less energetic or animated.8
Can my child become addicted to a stimulant?
Though stimulants are classified as habit-forming drugs, some research suggests that taking a stimulant to treat ADHD can actually reduce the risk of substance abuse in adolescence rather than increase it.9 However, children and teens are still at risk for abusing or selling their medication.10 Children and teens who do abuse the drug typically take it in higher doses or snort or inject the drug to achieve a quick and powerful high. To avoid these risks, keep the medication in a safe place, monitor the administration of the medication, and advise school personnel do the same.
What are common side effects of ADHD medications?
There are several common side effects of stimulant medications, which can include decreased appetite, weight loss, headaches, trouble sleeping, and stomachache. Height is not typically affected by stimulants, but the medication can slow or delay growth for the first two years of treatment.11 If your child is taking an antidepressant to treat symptoms, it’s important to monitor your child or teen for suicidal thoughts, a potential side effect of the medication.
Can a child still take ADHD medication if they have another medical or mental health issues?
It’s imperative that you talk to your child’s doctor about coexisting conditions and other medications they take. Children with Tourette’s syndrome may benefit from non-stimulant medication.12 Because stimulants can sometimes increase anxiety or agitation, it’s important to talk to your doctor about whether stimulants are the right starting point or not for a child with preexisting anxiety problems. Because stimulants are habit-forming, it’s also important to tell your doctor about any substance use problems with your child or teen.
Children with ADHD are also at higher risk for developing depression, so it’s important to talk to your child about their mood and mental health.13 Developing healthy coping habits at school and home can help reduce the risk now and in the future for additional mental health challenges.
Will my child always have to take medication for their ADHD?
Research has shown that with behavior therapy, some kids can work their way up to lesser doses of the medication.14 The necessity for treatment and the type of interventions may change as your child grows and changes. Some children may successfully discontinue medication therapy in their teens or adult years, whereas others may benefit from continued medical treatment.
Article Sources Last Updated: Feb 13, 2018