ADHD Medication Treatment

What is the most effective ADHD treatment?
Research shows that a combined approach of medication and behavioral therapy is the most effective treatment.

For moderate to severe cases of ADHD the first line of treatment is usually medication. ADHD medications called psychostimulants, which increase the amount of certain chemicals in the brain, help children focus and curb impulsivity and hyperactivity.

Behavioral therapies help kids rein in impulsive behavior and be better organized.

What are the kinds of stimulant medications for ADHD?
If a child has ADHD, studies show there’s an over 80% chance that he will respond to stimulant medication with a significant reduction in symptoms.
There are two main classes of stimulant medications:

  • Methylphenidate-based medications
    Ritalin, Methylin, Concerta, Metadate, Daytrana Patch
  • Dextroamphetamine-based medications
    Adderall, Vyvanse, Dexedrine

Of the children who respond to stimulants, half will respond equally well to both groups of medications, and the other half will respond better to one or the other. There are many different release formulas for stimulant medications, which make them effective for different periods of time.

  • Immediate-release formulas
    are effective for about 4 hours
  • Extended-release formulas
    last as long as 14 hours.

Within the extended-release group, medications vary in the doses they deliver morning and afternoon. Some deliver 50 percent in the first half of the day and 50 percent in the second; others deliver just 30 percent in the first half and 70 percent in the second.

Finding the right dose
Since different children metabolize medication in different ways, the goal is to find the formula that delivers an effective dose over a desirable period of time for your child. Getting the right dosage for a particular child takes several weeks of trial. The clinician normally increases the dosage gradually until it becomes effective. If your child experiences undesirable side effects, it may mean that the dosage is too high, or the medication isn’t right for her.

It’s important to note that some children respond differently to the two different stimulants used in these medications—methylphenidate and dextroamphetamine. Changing from one to the other, or even to a different release formula of the same basic medicine, can help reduce or eliminate side effects.

Once an effective dosage is established, your child should be monitored periodically to make sure it’s still meeting her needs as she grows.

Side effects of stimulant medications
Stimulant medications can be very effective in reducing symptoms of ADHD, but some kids do experience adverse side effects. They include:

  • Sleep issues
    If medication is interfering with a child’s sleep, it’s because the medication is still active at bedtime.
    If he’s taking a short-acting formula, it may mean that he is taking a second or third dose too late in the day. If he’s taking medication that lasts 12 or 14 hours, it may help to try one that’s not quite as long-acting. Sleep issues caused by the medication tend to get better over time, so it’s worth giving kids four to six weeks to see if they adjust. Trouble going to sleep may also be caused by kids being too stimulated at bedtime.
  • Eating issues
    Extended-release medicines, which peak about four hours after they’re taken, cause some children to lose their appetite at lunchtime. Some kids can compensate for this by eating a good breakfast before the medication kicks in, and eating well at the end of the day when the medicine is wearing off, at dinner and again before bedtime. Another option is to switch to the immediate-release tablets, which will wear off by lunch.
  • Growth issues
    Some kids, particularly boys, grow more slowly when they’re taking stimulant medication, especially in the first year. But studies show that by the second and third year they catch up. And kids who take weekend breaks and summer vacations from the medication don’t show the slow-down in growth.
  • Nausea and headaches
    These problems tend to dissipate within a few weeks of beginning medication, and can be minimized by taking the medication with food, and in some cases by changing the dosage or schedule.
  • Rebound
    In some cases, after the medication wears off a child becomes irritable and aggressive. We call this “rebound” and it means the medication is leaving the body too quickly. One way to avoid rebound, if it’s a problem, is by adding a smaller dose a half hour before it usually happens, to ease off the medication more gradually. Sometimes, rebound can be a sign that the clinician hasn’t got the right dose yet, or that a different medicine should be tried. Lastly, when a child rebounds, it’s important to consider whether there might be something else going on, like an underlying anxiety or mood issue that comes into play when she comes off her ADHD medicine.
  • Tics
    Some children who take stimulant medication develop tics. When that happens, the first thing your doctor might want to do is try a different stimulant, to see if another medication will work without the tics. If that doesn’t work, the doctor may try a non-stimulant medication, which affects the brain in a different way.
  • Mood changes
    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 dose needs to be reduced. But there is also a small subset of kids with ADHD who seem to get moody and sad or irritable when they take stimulant medications, even at 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, your doctor can try switching to a different stimulant, or a non-stimulant medication.

Are there non-stimulant medications for ADHD?
There are two types of medications that aren’t stimulants that can help alleviate symptoms of ADHD. They are useful for kids who don’t respond to stimulant medica-tions, or who experience adverse side effects from them.

  • Atomoxetine (sold as Strattera) 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 called alpha-adrenergic agonists.
    These medications were developed to lower high blood pressure, but at the doses given to kids for ADHD they rarely affect blood pressure.Both clonidine and guanfacine come in a 24-hour-release version (Kapvay and Intuniv), and they are sometimes used to treat tics.

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

Should children stop taking ADHD medication during holidays and the summer?
Since children with ADHD don’t need to perform academically during the summer or on extended holidays, parents sometimes seize the opportunity to take kids off their regular medication regimen, especially if they are experiencing side effects. Other parents avoid an interruption, fearing that their children’s behavioral problems will rebound.

One reason to stay with treatment year-round is that ADHD doesn’t only affect a child’s performance in school. During the summer, children still have to get along with family and friends and function effectively in group activities like sports and camp.

However, if you are concerned that taking a stimulant medication may be slowing your child’s growth, a summer break can allow him to catch up. And if you are concerned that he is underweight due to suppressed appetite, a summer without medication can help him put on some pounds.

For more on the pros and cons of a drug holiday, click here.