Medicines to Treat ADHD in Children

Children who have attention deficit hyperactivity disorder (ADHD) are often given medicine as part of their treatment plan. Healthcare providers often prescribe psychostimulants, such as methylphenidate. These medicines help balance chemicals in your child's brain that help to control their behavior and focus their attention.

Healthcare providers also prescribe other psychostimulants. These include dextroamphetamine, a mixture of amphetamine salts, and atomoxetine.

Psychostimulants act quickly. They do their job over 1 to 4 hours. They are then quickly flushed from the body. Some psychostimulants on the market are designed to be longer acting. They work for up to 9 hours and need to be taken only once a day.

Sometimes nonstimulant medicines may be used to treat ADHD in children. These include:

• Atomoxetine

• Guanfacine

• Clonidine

• Antidepressant medicines such as bupropion, desipramine, and imipramine

Your healthcare provider will determine your child's need for medicine and select the appropriate medicine. This is done after evaluating your child's symptoms, age and health, and your preference.

Before ADHD medicine is started, your child will be checked to be sure they meet certain standards for treatment. These can include:

• A full heart-focused health history, family history, and physical exam

• Baseline height, weight, blood pressure, and heart rate

• Baseline information for common side effects linked to ADHD medicines (such as belly pain, sleep patterns, and appetite)

• Substance abuse evaluation. Children with symptoms of substance abuse will be referred for evaluation and treatment for addiction before ADHD medicines are prescribed.

If these standards are met, then medicine education will be done. This can include talking about:

• The medicine choice

• The medicine dose, how often it should be given, and frequency of follow-up visits.

• The risks and benefits of treatment

• Possible side effects

• How long treatment is expected to take

• The behaviors and physical symptoms the family should watch for and report

Possible side effects

Psychostimulant medicines can cause side effects. But most are mild and ease with time. Side effects include trouble sleeping, decreased appetite, stomach ache, headache, and nervousness. When the medicine's effects wear off, some children's hyperactive behaviors may increase for a short while.

The FDA has ordered that medicine guides for parents be included with prescriptions for psychostimulants. That's because of recent reports of sudden death in children and teens with heart abnormalities who were taking these medicines for ADHD. A slightly increased risk for paranoia, mania, or hearing voices also happens in children who take these medicines.

When to take

The best time for your child to take a long-acting, once-a-day medicine is just after breakfast. Shorter-acting medicines are best taken 30 to 45 minutes before a meal, such as before breakfast and before lunch. 

Medicine can be taken during the week, and stopped on the weekend. Your healthcare provider can discuss if this is advised for your child. Some children don't do well stopping medicine for 2 days. They develop behavior problems. Medicine also is often stopped during the summer months when school is out. Your provider can talk with you about the right schedule for your child.

Other therapies

Some experts (and parents) criticize what they see as an overuse of psychostimulants. But these medicines have proven to be effective and safe for treating ADHD. Other treatment choices may be harder to follow, less effective, and sometimes not easily available to families. There are other options to psychostimulants medicines. These include:

• Behavioral counseling

• Educational support with smaller classes and personal attention

• Tutoring

• Training in social skills

Psychostimulants often are used along with other therapy. This includes behavioral and psychological treatment. Some parents have turned to such different treatments as biofeedback, megavitamins, and blue-green algae. Talk about any alternative treatments with your healthcare provider before trying them. This is even more important if your child is also taking medicines at the same time.

Whatever the treatment, if your child has ADHD, he or she may have trouble focusing even when they are grown up. Most children outgrow the hyperactivity and impulsiveness of their younger years. But as adults, they may still have trouble getting organized or finishing long-term projects.