For most children, stimulant medications are a safe and effective way to relieve attention-deficit/hyperactivity disorder (ADHD) symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior.
Stimulants may be used alone or combined with behavior therapy. Studies show that about 80% of children with ADHD who are treated with stimulants improve a great deal once the right medication and dose are determined.
Two forms of stimulants are available:
- Immediate-release (short-acting)
- Extended-release (intermediate-acting and long-acting)
Immediate-release medications usually are taken every 4 hours, when needed. They are the cheapest of the medications. Extended-release medications usually are taken once in the morning.
Children who use extended-release forms of stimulants can avoid taking medication at school or after school. It is important not to chew or crush extended-release capsules or tablets. However, extended-release capsules that are made up of beads can be opened and sprinkled onto food for children who have difficulties swallowing tablets or capsules.
Non-stimulants can be tried when stimulant medications don't work or cause bothersome side effects.
Which Medication Is Best For My Child?
It may take some time to find the best medication, dosage, and schedule for your child.
Your child may need to try different types of stimulants or other medication. Some children respond to one type of stimulant but not another.
The amount of medication (dosage) that your child needs also may need to be adjusted. The dosage is not based solely on his weight. Your pediatrician will vary the dosage over time to get the best results and control possible side effects.
The medication schedule also may be adjusted depending on the target outcome. For example, if the goal is to get relief from symptoms mostly at school, your child may take the medication only on school days.
It is important for your child to have regular medical checkups to monitor how well the medication is working and check for possible side effects.
What Side Effects Can Stimulants Cause?
Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived, but in rare cases they can be prolonged or more severe.
The most common side effects include:
- Decreased appetite/weight loss
- Sleep problems
- Social withdrawal
Some less common side effects include:
- Rebound effect (increased activity or a bad mood as the medication wears off)
- Transient muscle movements or sounds called tics
- Minor growth delay
Very rare side effects include:
The same sleep problems do not exist for atomoxetine, but initially it may make your child sleepy or upset her stomach. There have been very rare cases of atomoxetine needing to be stopped because it was causing liver damage. Rarely atomoxetine increased thoughts of suicide. Guanfacine can cause drowsiness, fatigue, or a decrease in blood pressure.
More than half of children who have tic disorders, such as Tourette syndrome, also have ADHD. Tourette syndrome is an inherited condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and tic disorders in most cases. It is also possible to use atomoxetine or guanfacine for children with ADHD and Tourette syndrome.
Most side effects can be relieved by:
- Changing the medication dosage
- Adjusting the schedule of medication
- Using a different stimulant or trying a non-stimulant
Close contact with your pediatrician is required until you find the best medication and dose for your child. After that, periodic monitoring by your doctor is important to maintain the best effects. To monitor the effects of the medication, your pediatrician will probably have you and your child's teacher(s) fill out behavior rating scales; observe changes in your child's target goals; notice any side effects; and monitor your child's height, weight, pulse, and blood pressure.
Stimulants, atomoxetine, and guanfacine may not be an option for children who are taking certain other medications or who have some medical conditions, such as congenital heart disease.
Are Children Getting High On Stimulant Medications?
When taken as directed by a doctor, there is no evidence that children are getting high on stimulant drugs such as methylphenidate and amphetamine. At therapeutic doses, these drugs also do not sedate or tranquilize children and do not increase the risk of addiction.
Stimulants are classified as Schedule II drugs by the US Drug Enforcement Administration because there is abuse potential of this class of medication. If your child is on medication, it is always best to supervise the use of the medication closely. Atomoxetine and guanfacine are not Schedule II drugs because they don't have abuse potential, even in adults.
Are Stimulant Medications Gateway Drugs Leading To Illegal Drug Or Alcohol Abuse?
People with ADHD are naturally impulsive and tend to take risks. But patients with ADHD who are taking stimulants are not at a greater risk and actually may be at a lower risk of using other drugs. Children and teenagers who have ADHD and also have coexisting conditions may be at higher risk for drug and alcohol abuse, regardless of the medication used. See ADHD and Substance Abuse: The Link Parents Need to Know.
You may have heard media reports or seen advertisements for "miracle cures" for ADHD. Carefully research any such claims. Consider whether the source of the information is valid. At this time, there is no scientifically proven cure for this condition.
The following methods need more scientific evidence to prove that they work:
- Megavitamins and mineral supplements
- Anti–motion-sickness medication (to treat the inner ear)
- Treatment for candida yeast infection
- EEG biofeedback (training to increase brain-wave activity)
- Applied kinesiology (realigning bones in the skull)
- Reducing sugar consumption
- Optometric vision training (asserts that faulty eye movement and sensitivities cause the behavior problems)
Always tell your pediatrician about any alternative therapies, supplements, or medications that your child is using. These may interact with prescribed medications and harm your child.
Additional Information on HealthyChildren.org:
The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community.