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Several medications are approved and shown to be effective through extensive testing across many years for treating attention-deficit/hyperactivity disorder (ADHD) in most children and adults. But they all have side effects, and healthcare providers usually prescribe them along with behavioral therapies.
Before you or your child begins treatment for ADHD, it’s crucial to get a proper medical diagnosis. You also need to know which of a range of symptoms are involved, how severe they are, and what combination of drugs and other therapies will be most helpful.
Symptoms and diagnosis of ADHD
ADHD is a behavioral condition that makes it hard to focus on normal tasks and routines (American Psychological Association, n.d.). About 8.7% of U.S. adolescents ages 13 to 18 have been diagnosed with ADHD at some point in their lives (NIMH, n.d.). Boys are more than twice as likely as girls to be diagnosed with the disorder (Danielson, 2018).
A person’s genetic make up plays a role in the disorder, but scientists don’t know exactly why some people get ADHD. 75% of children with ADHD were found to have a relative with the disorder (American Psychiatric Association, n.d.).
ADHD symptoms in children are the same as the symptoms in adults with the disorder. The list is long, and includes an inability to pay attention, focus, listen, or follow instructions for those who primarily struggle with attention (NIMH, n.d.). Others with ADHD show signs of hyperactivity and impulsivity and frequently fidget. They may also talk excessively and interrupt others (American Psychiatric Association, n.d.).
Diagnosing the disorder is a complex process involving evaluation by a psychiatrist, psychologist or primary care physician, or pediatrician (Wolraich, 2019).
There is no cure for ADHD, but the outlook for most children and adults with ADHD is encouraging, with solutions involving a long-term plan that blends behavioral therapies and medication for the patient and family counseling and training for parents (Wolraich, 2019).
Treatments are generally the same for kids and adults.
For children with ADHD younger than six, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. Behavioral management training has been found to work well, and it’s a skill parents and kids will need for the long haul. Sometimes the health care provider will still consider starting medication before the age of six years, for example when behavioral treatment isn’t available. From age six and up, healthcare providers may prescribe medication with or without behavioral therapy, but the two usually go together (Wolraich, 2019).
Stimulants are the main medications prescribed for ADHD in children and adults and have been extensively tested for effectiveness and safety. Taken as tablets, liquids, or through the skin via wearable patches, they stimulate the brain to release chemicals like dopamine to improve focus, though the exact mechanisms are not fully understood. Stimulants are designed to either work immediately and last up to a few hours or formulated for a slower release of 8 to 12 hours or more (Krull, 2020). Stimulants are controlled substances and require a schedule II prescription because they come with a high potential for abuse for people who take them recreationally (DEA, n.d.).
Stimulants can improve symptoms of ADHD, ranging from short attention spans to impulsive behavior and hyperactivity. They are effective in about 70-80% of the people who take them (Magnus, 2020).
Among the common stimulants and their brand names (Johns Hopkins Medicine, n.d.):
- Amphetamine salts (Adderall)
- Dextroamphetamine (Dexedrine, Dextrostat)
- Lisdexamfetamine (Vyvanse)
- Methylphenidate (Ritalin, Metadate, Concerta, Methylin)
Many ADHD drugs, including Adderall and Ritalin, are available in less-expensive generic forms.
ADHD medication dosage and interactions
Dosage is critical. The dosage is customized for each person based on age, symptoms, and other factors. In many cases, a healthcare professional won’t know in advance what drug will work best for a particular person, which is why they will often use a medication trial to figure out which medicine works best, and how much of it. The trial usually begins with a low dose that is gradually increased at 3–7 day intervals until clinical benefits are achieved (CHADD, n.d.). Dosages can sometimes be lower when medication is combined with behavioral therapies (American Academy of Child & Adolescent Psychiatry, 2013).
Other medications common among adults can trigger bad reactions in combination with ADHD drugs. If you seek care for ADHD, be sure to divulge any medications you might be on. In particular, drugs for diabetes, high blood pressure, depression, or anxiety can interact badly with stimulants (NIMH, n.d.).
ADHD medication side effects
Stimulants are generally considered safe when used as directed. But common side effects include reduced growth, which tends to self-correct over time and is not thought to impact adult height. Other common side-effects (Krull, 2020):
- Sleep problems
- Social withdrawal
- Anorexia or weight loss
These side effects are sometimes more pronounced in younger children, though they are typically mild and can usually be reversed by adjusting the dose or timing between doses. Less common side effects include headaches, dizziness, gastrointestinal issues, and heart rate and blood pressure increases. In rare cases, stimulants can cause priapism (a prolonged erection of the penis), psychoses such as hallucinations, delusional thinking, or mania (Krull, 2020).
Other medications and treatments for ADHD
There are other drugs used less often to treat ADHD (Krull, 2020):
- Atomoxetine (Strattera) may be prescribed as an alternative to stimulants if the patient or a family member has substance abuse problems or adverse reactions to stimulants. It is generally considered safe.
- Antidepressants may be tried, but usually only for children and adolescents who don’t respond well to stimulants or atomoxetine or had unwanted side effects of either.
- Alpha-2-adrenergic agonists are sometimes employed when stimulants don’t work or cause unwanted side effects. They take up to two weeks to start working, and there’s been limited study on their effectiveness.
- Other drugs are under investigation, and while some have shown promise, more research is needed on effectiveness and side effects.
Any ADHD medication should be accompanied by other long-term remedies and efforts mapped out with the help of healthcare professionals to include the following (American Academy of Pediatrics, 2019):
- A long-term plan with goals and monitoring
- Education of parents about the disorder and training in behavior management
- Teamwork to include parents, teachers, doctors, other caregivers, and, of course, the child
- Family and individual counseling
Adults with ADHD may also benefit from working with a coach to complement medication and other therapies. A coach, working with you as an individual or in a group, helps people with ADHD organize their life, think through goals, and maintain the focus to achieve them (CHADD, n.d.).
While it can be difficult to take powerful drugs or give them to a child, the symptoms of ADHD are also powerful. These symptoms can make school or work, and life itself, a tremendous challenge. Though there are side effects, and the meds do not work for everyone with the disorder, the commonly prescribed ADHD medications have been rigorously tested and found to be safe and effective for most people.
- American Academy of Child & Adolescent Psychiatry (2013), ADHD Parents Medication Guide. Retrieved from: https://www.aacap.org/App_Themes/AACAP/Docs/resource_centers/adhd/adhd_parents_medication_guide_201305.pdf
- American Academy of Pediatrics, Common ADHD Medications & Treatments for Children https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Determining-ADHD-Medication-Treatments.aspx
- American Academy of Pediatrics, Treatment & Target Outcomes for Children with ADHD https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Treatment-of-ADHD-and-Related-Disorders.aspx
- American Psychological Association, ADHD https://www.apa.org/topics/adhd
- American Psychiatric Association, What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), Understanding ADHD for adults. Retrieved from: https://chadd.org/for-adults/overview/
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), Medication Management Retrieved from: https://chadd.org/for-adults/medication-management/
- Johns Hopkins Medicine, Attention-Deficit / Hyperactivity Disorder (ADHD) in Children https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdadd
- Krull K. UpToDate (2020). Pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents. Retrieved from: https://www.uptodate.com/contents/pharmacology-of-drugs-used-to-treat-attention-deficit-hyperactivity-disorder-in-children-and-adolescents
- Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK441838/
- National Institute of Mental Health, Could I Have Attention-Deficit/Hyperactivity Disorder (ADHD)? https://www.nimh.nih.gov/health/publications/could-i-have-adhd/index.shtml
- U.S. Centers for Disease Control and Prevention (CDC), Attention-Deficit / Hyperactivity Disorder (ADHD): Treatment of ADHD https://www.cdc.gov/ncbddd/adhd/treatment.html
- UpToDate (2021) Pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents. Retrieved from https://www.uptodate.com/contents/pharmacology-of-drugs-used-to-treat-attention-deficit-hyperactivity-disorder-in-children-and-adolescents
- United States Drug Enforcement Administration (DEA). Drug Information. https://www.dea.gov/drug-scheduling
- U.S. Centers for Disease Control and Prevention, Attention-Deficit / Hyperactivity Disorder (ADHD) https://www.cdc.gov/ncbddd/adhd
- Mark L. Wolraich, Joseph F. Hagan, Carla Allan, Eugenia Chan, Dale Davison, Marian Earls et al. (2019) Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, American Academy of Pediatrics, October. Retrieved from https://pediatrics.aappublications.org/content/144/4/e20192528
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.