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ADHD medication: What you should know

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By Shashank V. Joshi, M.D.,FAAP

Watching for side effects

Medication side effects are usually transient and minimal. Your child's practitioner will go over specific side effects, depending on what is prescribed. In general, stimulants are known to cause headache, stomachache, small increases in blood pressure and pulse, appetite suppression, and sleep difficulties. Less common side effects include irritability, mood changes, unmasking of tics, and slowing of the speed of growth in height. All of these are responsive to simple interventions, such as giving the dose with food, lowering the dose, changing its timing, or switching to another medicine.

Recently, the FDA has included new warnings regarding the use of Strattera (atomoxetine) — it has, on rare occasions, been associated with suicidal thinking in teenagers — and also for psychostimulants (they have a rare association with severe cardiac side effects and sudden death, primarily for children with a history of certain pre-existing heart problems).

The FDA link regarding drug safety information for patients and families can be found at here.

Talking with your child

How you talk to your child about medication depends, in large part, on your child's developmental stage. Younger children (5 to 7 years old) need reassurance they're not "bad" kids. They need to know their parents understand that they're trying really hard to behave, pay attention in class, or stay in their seat. The medicine will make it easier for them to succeed because it allows them to make good choices and be in control of their behavior and attention, rather than being controlled by their behavior.

Older school-aged and preteen children (8 to 12 years old) also need constant reminders about, and attention to, things they can do well, rather than having their parents dwell on their difficulties. Medical analogies can be helpful, like, "You know how getting eyeglasses helped you [or your friend or your cousin] a lot with schoolwork? That's sort of how this medicine is supposed to help too."

Teens need to know it's not "all about the pill." When their grades turn around, they did it; the medication simply allowed them to focus long enough to actually get the work done. The teen still had to do the homework or finish the paper. Meds can't take tests! Emphasize that you, he, the doctor, and his teachers are all on the same team, trying to help him succeed.

Managing medication at school

Just as it's usually not a good idea to keep family secrets, keeping school personnel in the dark about your child's ADHD is generally not helpful either. While it may be difficult to secure appropriate accommodations at certain schools, most schools do want to support their students. Your child's practitioner, school psychologist, or counselor may have some practical classroom suggestions. Work with your child's teacher to create a special "signal" (e.g., a gentle squeeze on the shoulder, or an opportunity to do a special errand) when it's time to go to the office or nurse's station to take midday medication. Once-daily preparations make these kinds of arrangements unnecessary, but for those who respond better to shorter-acting agents, it's crucial for maintaining confidentiality.

Comments from readers

"Keep your kids -- or anybody, for that matter -- away from Strattera. Causes rage in even the lowest doses, esp. in children and young adults. "
"This video is pretty interesting and might give people some food for thought on treating ADHD with their children. We had our children on medication after their diagnoses, but since have take them off. We're sure it's on a case by case basis, but they have shown improvements with our alternate methods (and guidance from their doctor)."
"I am so thrilled that there is so much helpful information on here about medications when your child has ADHD. I now can understand much more about how the medicine may effect my son. My son is 4 with mainly impulsive issues and behavior in reguards to ADHD but also a communication disorder. So it gets pretty complicated. We tried Metadate CD and my son was talking more,but more hyper and then began to get extremely over-emotional and had crying spells all night,it was very hard to go through that and see him that hyper and it was scary. My concern was,what was it doing to his thoughts? His ability to communicate? He can't tell me but I can see it doing something. Now we are considering Strattera,but Medicaid won't cover it but my son's develop. pediatrician said we can try samples to see if it will work. What is the best treatment for a child with ADHD and developmental disorders/communication/sensory/fine-motor,do you think medication would interfere with these other under! lying disorders? I also have read articles about kids being diagnosed with ADHD when they really have Bi-polar.(My son does have all those red-flags) I am spinning in' disorders',could you please help? "
"Good article and helps us parents who may be dealing with this. "
"Please continue to provide the Public with this Helpful Information. I have 12 year old son with ADHD and it drive me crazy, I get daily calls form his teachers on his behavior, when he's not on his Meds. He been taken Focalin for more than a Year now It works Great. He's a smart kids he gets great grades in school it just he has trouble sitting still I've witness this first hand. When he Home I find things for him to do He loves video games beats them In a few weeks and trades them In for a New One. It hard to keep him attention. I really really enjoy all the Information you have posted its verry helpful, mothers are the Ones who suffer as well alon with the child. Question: Has there been any research as to why this Illness has come about? Laverne Newton South Carolina."