What You Need to Know About Stimulant Medication

Stimulant medications are thought to work by stimulating the brain to make available slightly more of the brain chemicals (neurotransmitters) that help our brain cells communicate more efficiently. This increased efficiency allows us to better focus our attention, control impulses, organize, plan, and stick to routines—leading to a reduction in the core ADHD symptoms of hyperactivity, inattention, and impulsivity.

Parents of a child with ADHD who is taking stimulants may notice a decrease in the number of accidental injuries their child experiences as her impulsivity declines. They may also observe that her social relationships may improve as her intensity decreases, her social judgment improves, she responds more positively to others, and she is able to communicate more effectively. The significant improvement in the child’s school behavior—sometimes to the point that it is indistinguishable from that of her classmates—is particularly satisfying to most children and their families. Children treated with stimulants for ADHD can also enjoy a longer attention span, an increased ability to stay focused on a task, and more productivity and accuracy in schoolwork.

Once again, stimulants are generally considered highly effective and safe medications. They are, though, categorized by the US Drug Enforcement Administration as Schedule II drugs—medications that have been approved for medical use but have a high potential for abuse in adults if they are not used properly. Because of this, the rules for prescribing stimulants may differ from those for other medications (such as antibiotics) from state to state. Although there is a lot of discussion in the media about the potential for the abuse of stimulant medications, they don’t produce speed-like or euphoric effects in children or adolescents when used properly and restricted to normal treatment doses. In addition, the use of stimulants by children with ADHD has not been found to put adolescence at an increased risk for street drug use.

Stimulants work similarly in people who do and do not have ADHD—they can help most children and adults achieve better focus and concentration. Because of this, having a positive response to stimulants is not a test of whether a child has ADHD. Nor does needing a higher dose than another child mean that your child’s symptoms are more severe. Doses vary with the individual regardless of the severity of symptoms. Some children with mild symptoms may need higher doses of medication while others with more severe symptoms require lower doses.

Medications can be described by their generic (chemical) names but are most often known to parents by their brand names. The 2 generic classes of stimulants proven to be effective for the treatment of ADHD are methylphenidate and amphetamines. The brand names of the methylphenidate preparations currently available to children with ADHD are Ritalin, Metadate, Methylin, Focalin, Concerta, and Daytrana. A number of different amphetamine medications are also available and include Dexedrine, Dextrostat, Vyvanse, Dexedrine Spansules, and Adderall.

Both classes of stimulants have similar effects and side effects. Different preparations also have different durations of action, as described in the table below. Comparing doses of different medications can be confusing to parents. The amount of each medication prescribed (in milligrams per dosage or per day) is unique to that particular medication—so, for example, 5 mg of methylphenidate (Ritalin) is only about half as strong as a dose of 5 mg of dextroamphetamine (Dexedrine).

FDA-Approved Medications—Dosing and Pharmacokinetics
First-line Medications Used in the Treatment of ADHD