Ask An Expert / Medication

Stimulant medications helped my son with ADHD, but he developed tics. Is there something else we can try?

Two other kinds of medications may help with symptoms, without the side effects

Alan Ravitz, MD, MS

My 7-year-old son has ADHD. His dominant symptoms are hyperactivity, distractibility, and anxiety. He spent most of first grade on low-dose stimulant medication (Adderall and Ritalin), but it brought out significant tics, reduced his appetite significantly (he hardly gained any weight last year) and may have made anxiety worse as well (not sure). I feel that he would benefit socially and academically from medication for his hyperactivity and distractibility. Is there something else we can try?

There are two types of medications that aren’t stimulants that can help alleviate symptoms of ADHD but are less likely to cause tics.

One is called atomoxetine (sold as Strattera), which is in a class of drugs called norepinephrine reuptake inhibitors. Norepinephrine is a natural substance in the brain that is needed to control behavior.

Clonidine (Catapres, Nexicon) and guanfacine (Tenex) are also prescribed for children with ADHD who don’t tolerate stimulants well. Called alpha-adrenergic agonists, these medications were developed to lower high blood pressure, but at the doses we give kids they rarely affect blood pressure

Both clonidine and guanfacine come in a 24-hour-release version (Kapvay and Intuniv), and they are actually sometimes used to treattics. Parents have found that they also help kids with sleep, and, since they are active around the clock, they help children who have a lot of trouble getting up and ready for school in the morning.

Before trying one of these medications, you might want to try several different stimulants, to see if another medication will work without the tics and other side effects. You could try several dextroamphetamine derivatives (sold as Adderall, Vyvanse, and Dexedrine) as well as a range of methylphenidate (Ritalin, Methylin, Concerta, Metadate, Daytrana Patch). Focalin is another option in the latter group; it’s based on methylphenidate but it has only half of the molecule, and some kids with tics do better on it.

Finally, Omega fatty acids can also be helpful for ADHD, though not as helpful as stimulants or these other medications.