By Annie Stuart
If your child has been diagnosed with attention-deficit /hyperactivity disorder (AD/HD), then you probably know medication is often prescribed to help manage this condition. Many types of AD/HD medication are available, and they work in slightly different ways. If one doesn't work well for your child, you can talk to his doctor about other choices.
Keep in mind that taking medication is just one part of your child's treatment program. Counseling, making accommodations in school, behavior management, and other strategies may also be recommended.
At this time, there are several classes of medication used to help manage AD/HD in children: stimulants, selective norepinephrine reuptake inhibitors, antidepressants, and antihypertensives. Of these, only the stimulants and the selective norepinephrine reuptake inhibitor have been approved by the U.S. Food and Drug Administration (FDA) for treating AD/HD in children. However, there is ample evidence the other classes of medication may also be useful in treating AD/HD symptoms in children.
Your child's doctor will work with you to find which type works best for your child. It's important for you to know how each class of medication works to treat AD/HD.
Stimulants are the medications most often used to treat AD/HD. About 70-90 percent of children show improvement in AD/HD symptoms while on this type of medication. Stimulants can decrease hyperactivity and impulsive actions. They can also improve a child's ability to concentrate on tasks or follow directions. Stimulants do this by increasing levels of certain neurotransmitters, or biochemicals in the brain, including dopamine and norepinephrine. Stimulants have been in use since the 1930s and are among the most studied of all medications. Stimulants prescribed for AD/HD include Ritalin®, Concerta®, Methylin®, Dexedrine®, Dextrostat®, Adderall®, Metadate®, and Focalin®.
Many stimulants are now available in both short-acting and long-acting formulations. Some stimulant formulations can be given just once daily. For children who have difficulty swallowing pills, Methylin is now available as a chewable tablet and as an oral solution (liquid). Another option is a methylphenidate transdermal patch called Daytrana®.
The newest stimulant medication approved by the FDA is Vyvanse®, which is categorized as a "prodrug" because it is inactive until metabolized by the body. It may last 8-10 hours and has been shown to have a lower abuse potential than traditional amphetamine.
Your child's doctor can tell you what options are available and what might be most helpful for your child.
In December 2002, the FDA approved this new medication for treating AD/HD in children. This medication is not a stimulant, but it helps manage the same AD/HD symptoms stimulants do. Scientists believe it works by blocking or slowing the reuptake of norepinephrine, a neurotransmitter that regulates attention, impulsivity, and activity levels in the brain. The drug Atomoxetine is marketed under the brand name Strattera® and is taken once or twice daily. Prior to FDA approval, Atomoxetine was tested extensively on children, adolescents, and adults. Unlike stimulant medications, Strattera® is not a controlled substance, and researchers believe it does not carry the risk of substance abuse, which is a concern in some high-risk populations.
Certain antidepressants may reduce hyperactivity, aggressiveness, or attention problems in children with AD/HD. They may be an alternative to stimulants when those medications have not worked well or when side effects persist.
Tricyclic antidepressants appear to work by making more neurotransmitters available in the brain. They are sometimes prescribed when treatment with stimulants causes severe side effects. Children who take these antidepressants may have an increased risk for heart problems. Many doctors monitor a child's heart activity before and during treatment with this type of antidepressant. Common tricyclic antidepressants used to treat AD/HD include Tofranil®, Norpramin®, Elavil®, Pamelor®, and Effexor®.
Wellbutrin® is a unique antidepressant used to treat AD/HD. It works rapidly and enhances dopamine transmission in the brain. It's often helpful in depressed children who have severe mood swings.
Antihypertensive medications may be used instead of stimulants for children who have severe side effects to stimulants or who have serious behavior problems. The sedating effect of these medications may help reduce some symptoms, such as hyperactivity and aggressiveness. To a lesser degree, they may help with a child's attention problems. (Antihypertensives are used to control high blood pressure in adults but appear to have little effect on children's blood pressure when taken daily.) A history of the child's heart health and a physical exam are recommended before starting treatment. Catapres® and Tenex® are the most common hypertensives prescribed for AD/HD.
Before starting your child on any medication, be sure to ask your child's doctor and pharmacist about possible side effects. If side effects do occur, report them to the doctor right away.
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