ADHD, or attention deficit hyperactivity disorder, is one of the most prevalent childhood conditions. In a classroom of 30 children, statistically, there’s a good chance that at least two or three of the students will have ADHD.
To understand how the medication used to treat ADHD works, we need to understand a little about the disorder itself. ADHD is a neurodevelopmental disorder, meaning that it’s caused by a “disorder” in the electrical impulses within the brain that determine behavior. While it’s normal for children to have a short attention span or be very active, children with ADHD experience these issues at levels that make it difficult for them to learn or engage with others in a healthy way.
While it sounds contrary to the desired outcome for a child with ADHD (most parents want their children to calm down, not be stimulated), ADHD medications are generally stimulants that work by “stimulating” certain areas of the child’s brain, reducing unhealthy impulses and allowing the child to exercise more focus and self-control. This most commonly can help with learning and focusing on tasks. Successful management of ADHD can have a significant effect on a child’s long-term chances at a healthy and productive life.
While ADHD medications can help with such problems as impulsive behaviors and short attention span, it is not always true that these medications help with other problems, such as oppositional behaviors and problems relating to parents and others. These issues may require other medications or psychological counseling.
Two Main Medications for ADHD
There are two widely used medications that are most commonly prescribed to treat ADHD: methylphenidate (Ritalin) and Adderall. About 80 percent of children with ADHD respond well to treatment from these or related medications.
Methylphenidate is a stimulant available under several name brands, including Concerta, Focalin, Metadate, Methylin and Ritalin. It can be prescribed in a capsule, tablet or liquid. There is also now a patch available, Daytrana, that can be worn on the skin.
Adderall, like methylphenidate, is also a stimulant available in short-acting and long-acting dosages. Related medications include Dexedrine, Dextrostat and Vyvanse.
For the other twenty percent of children who do not respond well to these medications, there are alternatives such as Strattera (atomoxetine) or guanfacine (Tenex).
Some forms of ADHD medication are “short-acting,” usually beginning to work within a half-hour of taking the dosage, which may be taken two or three times a day. Other forms of the medications are long-acting, which take longer to work but may only be taken once per day.
Starting ADHD Medication
Your child’s physician will work with you in monitoring and adjusting the medication and dosage to achieve the right outcome. We tend to begin the medication at a very low dose and increase it gradually until we find the right dosage. Usually, a doctor will wait three to seven days before adjusting a child’s dose to ensure that the adjustment is necessary. The prescription and adjustments to dosage may be started over a weekend, when a parent can more closely observe his or her child. It may take a significant amount of time and several doctors’ visits to establish the proper dose for each individual child.
Your child’s physician will also work with you to identify possible side effects caused by the medication, which can include weight loss, moodiness, loss of appetite and trouble sleeping. Less common side effects that children experience include stomach pain, headaches, increased nervousness and increased blood pressure. It is not unusual for a child to experience some side effects during the first few days of treatment, but most children adjust fairly quickly and should not experience these problems on a persistent and sustained basis. It may be necessary to change a prescription or dosage several times to find one that has the desired effect with the fewest side effects.
Keeping Medication Safe
There is an increasing market for ADHD medications beyond their prescribed usage, especially among people who want the medications to help them improve their concentration and productivity. Many college campuses are coping with students who abuse ADHD medications — as well as something of an emerging “black market” of those who sell the medications to students who do not have a prescription.
It should be noted here that ADHD medications have an extremely low potential for abuse or addiction if they are used properly and under the close supervision of a health care provider.
It’s important to treat ADHD medication just as you would any other medication that might be subject to abuse, such as opioids. Keep it out of the reach of children and protect it from anyone who might steal it or abuse it.
If the child needs to take medication at school, ask for a separate bottle. That bottle should be given to a school nurse or other appropriate faculty member for safe keeping and to be sure the child receives the correct dosage at the appropriate time during the school day. Children should not keep the medication in their book bags, desks or lockers. Medication also should not be kept in a car where it’s not only susceptible to theft, but to being stored at unsafe temperatures.
Taking a Medication Holiday
One good thing about most ADHD medications is that, unlike some other prescriptions, they can be safely stopped at any time.
Some children and parents may speak to their doctor about taking a “medication holiday,” and not using the medication for a day or more at a time. This is often an option over weekends or breaks from school. It also gives children, parents and medical providers a chance to see how well the medication is (or is not) working.
Medicine Isn’t the Only Answer
Medication is a useful — and very effective — approach to helping children with ADHD, but it’s only part of the equation for successful treatment. Behavioral treatments are also important.
Your child’s physician may recommend a number of things that parents can do to help children with ADHD, including:
- Setting a daily schedule
- Rewarding positive behavior
- Using charts, checklists and other tools to help children stay organized and on task
- Limiting choices
- Giving children breaks for physical activity throughout the day
- Maintaining a calm demeanor and environment
Psychological counseling is a useful adjunct for some children with ADHD.
You can read more about how medicinal therapies for ADHD in Tanner’s online Health Library, where you can also find drug reference information for a number of ADHD medicinal therapies.
The following are two highly recommended websites for parents:
- www.healthychildren.org: this website is sponsored by the American Academy of Pediatrics, and has numerous up-to-date resources for parents.
- www.chadd.org: this website is sponsored by the largest non-profit organization devoted to ADHD and has a wealth of resources.