Children with ADHD can have a short attention span and/or problems being hyperactive and impulsive.
Although many young kids may seem like they get distracted easily, can't pay attention for very long when they are doing school work or even playing, do things impulsively, and can be hyperactive at times, kids with ADHD experience an impairment from these symptoms. That means that they may not do well at school, may have trouble making or keeping friends, and may even have problems at home and with after-school activities.
Fortunately, treatments can help to control the symptoms of ADHD in most kids.
These treatments typically include ADHD medications and behavioral therapy, whether it is formal behavioral therapy with a child psychologist or counselor, or just simple steps that parents and teachers learn to modify a child's behavior to help them get more organized, avoid distractions, and behave more appropriately.
ADHD medications have long been a core part of the treatment plans for many kids with ADHD.
These ADHD medications now include:
- Short Acting Stimulants: Adderall, Dexedrine, Focalin, Ritalin
- Intermediate Acting Stimulants: Dexedrine Spansule, Metadate ER, Ritalin SR
- Long Acting Stimulants: Adderall XR, Concerta, Daytrana, Focalin XR, Metadate CD, Ritalin LA, Vyvanse
- Nonstimulants: Intuniv, Strattera
That list makes it seem like there are a lot of different ADHD medications to choose from, especially if your child has side effects to one or more of the medications. Your choices quickly narrow when you understand that the stimulants are really just different forms and variants of just two types of ADHD medications -- methylphenidate (Ritalin) and amphetamine based medications:
- methylphenidate (Ritalin) based ADHD medications: Concerta, Daytrana, Focalin and Focalin XR, Metadate CD and Metadate ER, Ritalin LA and Ritalin SR
- amphetamine based ADHD medications: Adderall and Adderall XR, Dexedrine and Dexedrine Spansule, Vyvanse
Why so many ADHD medications if they are so similar? In some cases, these medications simply have different delivery methods that make them last longer. For example, Concerta is supposed to last 12 hours, while Ritalin SR typically only lasts about 8 hours, even though they both have methylphenidate as their active ingredient. In other cases, the way you take the medication is totally different, such as the Daytrana patch delivery system.
Side Effects of ADHD Medications
Although these ADHD medications help many kids manage their ADHD symptoms, some parents are still hesitant to start their child on a medicine like Ritalin or Adderall because they are worried about possible side effects.
In some cases, those worries are justified. Stimulants used to treat ADHD are notorious for causing a decreased appetite, weight loss, insomnia, and headaches.
Many of these side effects are temporary, or can be easily managed by decreasing the medication's dosage.
Some parents are worried about the stigma of taking an ADHD medication, are concerned about controversies over Ritalin, or are worried that the medications will make their child angrier, more aggressive, or even too calm, like a zombie. Fortunately, these are not common side effects of ADHD medications, and if they do occur, your pediatrician would likely either stop the medication or lower the medication's dosage.
Other side effects that parents are often concerned about when starting their child on an ADHD medication can include:
- Tics - The worry over tics is likely because all stimulants list tics as a contraindication to their being prescribed. Many ADHD experts do not think that stimulants, such as Ritalin, actually cause or worsen tics though, and that ADHD and chronic tic disorders might simply occur together in some children.
- Sudden Death - Stimulants also carry a warning that they may cause sudden death in children with structural heart problems or other serious heart problems, such as cardiomyopathy or serious heart rhythm abnormalities. Remind your pediatrician about any known heart problems your child has before starting a stimulant to see if an EKG or alternative medication might be indicated.
- Suicide - Strattera has a warning about an increased risk for suicidal thoughts, which makes it important to monitor your child for changes in mood or behavior when starting or changing doses of Strattera.
Minimizing Side Effects
One of the best ways to minimize the side effects of an ADHD medication is to have realistic expectations for what you think the medication is going to do for your child. For example, if your child is so hyperactive and impulsive that he gets in trouble every day in school, it may be okay if he still gets in a little trouble for talking once every few weeks.
Pediatricians, parents, and teachers some times get in trouble when they continue to push medication dosages to try and get total control of ADHD symptoms, when the goal maybe should be to simply decrease disruptive behaviors, improve performance at school, and improve relationships with family and friends.
Other tips to minimize side effects from ADHD medications:
- Start with a low, age-appropriate starting dose of the medication.
- Under the guidance of your pediatrician, increase the medication every one to three weeks until it seems to be working well or your child begins to have side effects.
- Consider a switch to a different type of ADHD medication if your child begins having too many side effects that aren't helped by lowering the medication dosage. For example, if your child is taking an amphetamine based ADHD medication, such as Vyvanse, then you would likely switch to a methylphenidate (Ritalin) based ADHD medication next.
- Ask your pediatrician if your child can take his dose of Strattera at bedtime if it is causing a lot of drowsiness.
- Consider a few extra healthy snacks and high calorie foods if his main side effect is a decreased appetite and weight loss or trouble gaining weight.
- See your pediatrician for regular ADHD checkups, and at least every three to six months, to monitor your child's heart rate, blood pressure, and height and weight to make sure he is growing well.
- Understand that you may not be able to control all of your child's ADHD symptoms with medication, especially if he is having side effects at high dosages. Simply decreasing the severity of the symptoms may have to be your goal, combined with behavioral therapy, and maybe even modifications at school.
- If your child isn't doing well after trying several ADHD medications and different dosages, instead of continuing to try higher dosages, which may increase the chance of side effects, consider that he may not actually have ADHD or he may have have a coexisting disorder, such as depression or a learning disability.
American Academy of Pediatrics. Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder. PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1033-1044.
Journal of the American Academy of Child and Adolescent Psychiatry. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Volume 46, Issue 7 (July 2007).