Children who have ADHD are often given medication as part of their treatment plan. The type of medication most often chosen is a psychostimulant, such as methylphenidate (Ritalin, Metadate and Concerta). Psychostimulant drugs help balance chemicals in the child's brain that help to control behavior and focus attention.
Other psychostimulants prescribed for ADHD in children include dextroamphetamine (Dexedrine), a mixture of amphetamine salts (Adderall), and atomoxetine (Strattera).
Psychostimulants act quickly—doing their job over the course of one to four hours—and then are quickly flushed from the body. Newer psychostimulants on the market are designed to be longer acting, continuing to work for up to nine hours, so that they only need to be taken once a day.
Occasionally, nonstimulant medications may be used to treat ADHD in children. These include the antidepressants bupropion (Wellbutrin), desipramine (Norpramin), and imipramine (Tofranil).
Your health care provider will determine the need for medication and select the appropriate drug after evaluating your child's symptoms, his age and health, and your preference.
Possible side effects
Psychostimulant medications can cause side effects, but most are mild and ease with time. Side effects include insomnia, decreased appetite, stomach ache, headache, and nervousness. In addition, when the medication's effects wear off, some children's hyperactive behaviors may increase for a short while.
The FDA has ordered that medication 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 medications for ADHD. There is a slight increased risk for paranoia, mania, or hearing voices in youngsters who take these medications. The FDA also has warned that children and teens who take antidepressants may be more likely to become suicidal.
When to take
The best time for your child to take a long-acting, once-a-day medication is just before breakfast. Shorter-acting medications are best taken 30 to 45 minutes before a meal—before breakfast and before lunch, the AAFP says.
Medication is usually taken during the week, with a drug "vacation" on the weekends. Medication also is often stopped during the summer months, when school is out. Your health care provider can discuss the appropriate schedule for your child. Some children need medication for several years; others need longer treatment.
Although some experts (and parents) criticize what they see as an overuse of psychostimulants, these medications have proven to be effective and safe for the treatment of ADHD. Other treatment options may be harder to follow, less effective, and sometimes not easily available to families. Alternatives to Ritalin and other stimulants include ongoing counseling for the child, educational support in the form of smaller classes and individualized attention, tutoring, and training in social skills.
Psychostimulants often are used in conjunction with other therapy, such as psychological treatment. Some parents have turned to such different treatments as biofeedback, megavitamins, and blue-green algae. Any alternative treatments should be discussed with your health care provider before trying them.
Whatever the treatment, a child with ADHD may find that he has trouble concentrating even as he grows up. Most children outgrow the hyperactivity and impulsiveness of their younger years, but as adults still have difficulty getting organized or completing long-term projects. They often do best with careers that draw on their strengths and make the most of their behavior style—they become entrepreneurs or artists and entertainers.