From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
FREE Newsletter. Sign Up Now!

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

With all of the different types of medications available to treat ADHD, and many new ones, how do you choose which one to use for your child? Which one works best? In general, there is no one 'best' medicine and the AAP states that 'each stimulant improved core symptoms equally.'

The other question is what dosage to use. Unlike most other medications, stimulants are not 'weight dependent,' so a 6 year old and 12 year old might be one the same dosage, or the younger child might need a higher dosage. Because there are no standard dosages based on a child's weight, stimulants are usually started at a low dosage and gradually increased to find a child's best dose, which 'is the one that leads to optimal effects with minimal side effects.' These side effects can include a decreased appetite, headaches, stomachaches, trouble getting to sleep, jitteriness, and social withdrawal, and can usually be managed by adjusting the dosage or when the medication is given. Other side effects may occur in children on too high a dosage or those that are overly sensitive to stimulants and might cause them to be 'overfocused on the medication or appear dull or overly restricted.' Some parents are resistant to using a stimulant because they don't want their child to be a 'zombie,' but it is important to remember that these are unwanted side effects and can usually be treated by lowering the dosage of medication or changing to a different medication.

And because 'at least 80% of children will respond to one of the stimulants,' if 1 or 2 medications don't work or have unwanted side effects, then a third might be tried. If a child continues to respond poorly to treatment, then a reevaluation might be necessary to confirm the diagnosis of ADHD or look for coexisting conditions, such as oppositional defiant disorder, conduct disorder, anxiety, depression, and learning disabilities. If necessary, at this time, second line treatments might be tried, including tricyclic antidepressants (Imipramine or Desipramine) or bupropion (Wellbutrin). Clonidine is also sometimes used, especially for children with 'ADHD and coexisting conditions, especially sleep distrubances.'

In addition to stimulants, the policy statements recommends the use of behavior therapy, which might include parent training and '8-12 weekly group sessions with a trained therapist' to change the behavior at home and in the classroom for children with ADHD. Other psychological interventions, including play therapy, cognitive therapy or cognitive-behavior therapy, have not been proven to work as well as a treatment for ADHD.

Other interesting facts about ADHD mentioned in this policy statement include that:

• 60-80% of children with ADHD continue to have symptoms in adolescence
• 4-12% of school age children are thought to have ADHD
• Commonly used stimulants do not require 'serologic, hematologic or electrocardiogram monitoring.' Although monitoring of liver function tests was required for children taking Cylert (which isn't commonly used anymore), the use of other stimulants doesn't require any routine blood tests.
• Stimulants can cause unpredictable effects on motor tics, which transiently occur in 15-30% of children taking stimulants, but the 'presence of tics before or during medical management of ADHD is not an absolute contradindication to the use of stimulant medications.'

Although not a blueprint for how to treat children with attention deficit hyeractivity disorder, the AAP policy statement on the Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder is very helpful for physcians taking care of children with this challenging and often controversial disorder. It can also help to educate parents about what treatment options are available, and when they should seek additional help.

Since it is a newer medication, this policy statement did not address the use of Strattera, which is not a stimulant, for the treatment of kids with ADHD.