If your child has been diagnosed with attention-deficit /hyperactivity disorder (ADHD), then you probably know medication is often prescribed to help manage this condition. Many types of ADHD 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.
Medications used to treat AD/HD
At this time, there are several classes of medication used to help manage ADHD 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 ADHD in children. However, there is ample evidence the other classes of medication may also be useful in treating ADHD 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 ADHD.
- Stimulants Stimulants are the medications most often used to treat ADHD. About 70-90 percent of children show improvement in ADHD 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 ADHD 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.
- Selective norepinephrine reuptake inhibitor In December 2002, the FDA approved this new medication for treating ADHD in children. This medication is not a stimulant, but it helps manage the same ADHD 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.
- Antidepressants Certain antidepressants may reduce hyperactivity, aggressiveness, or attention problems in children with ADHD. 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 ADHD include Tofranil®, Norpramin®, Elavil®, Pamelor®, and Effexor®.
Wellbutrin® is a unique antidepressant used to treat ADHD. It works rapidly and enhances dopamine transmission in the brain. It‘s often helpful in depressed children who have severe mood swings.
- Antihypertensives 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 ADHD.
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.
Becoming familiar with medication terms
As you learn about ADHD medications, you may read or hear some unfamiliar terms. Here are some definitions you may find helpful:
- Clinical trial: a scientific test of the effectiveness of a medication or other type of treatment on human volunteers.
- Combination treatment: two or more different types of treatment used at the same time, such as medication and a home-school behavior management plan.
- Comorbid conditions: two or more medical conditions that occur in a person at the same time.
- Controlled substance: a medication that has the potential for abuse and so requires close supervision by a physician; by law, these medications require a special prescription that must be filled within a few days and can’t be refilled automatically.
- Drug holiday: a “break” from treatment during the summer or school holidays; sometimes recommended by physicians to see if medication is still needed or to improve a child’s physical growth, if medication has inhibited it.
- Drug tolerance: the ability to resist any harmful effects from the continued or increasing use of a medication.
- Frontal lobe: the front part of each cerebral hemisphere of the brain; the part of the brain associated, among other things, with the control and regulation of attention, arousal, and activity.
- Long-acting (sustained release): a medication that is designed to be slowly released in the body over an extended period of time.
- Neurotransmitters: biochemical substances in the brain responsible for normal communication between nerve cells.
- Pharmacotherapy: medication therapy.
- Short-acting: a medication that is designed to be quickly released in the body over a short period of time.
- Tapering: gradually taking less and less medication before stopping its use; often done to reduce the side effects from stopping medication suddenly.
- Transdermal patch: an adhesive patch that contains prescription medication. The patch is applied to the skin as the means for delivering medication to the body.
New medications are being developed to manage ADHD. Some medications that are used to treat other health conditions are now being studied for possible use in managing ADHD. Several natural remedies for managing ADHD are also undergoing research and evaluation.
For more information about medications used to treat ADHD, speak to your child’s physician or pharmacist and check the resources at the end of this article.
Warnings about possible side effects of prescription medications are updated frequently. To stay abreast of recent warnings that may have been issued on your child’s medication, visit the U.S. Food and Drug Administration Consumer Education/Information website, and ask your pharmacist for an update each time you refill the prescription.
ADHD by other names and acronyms
While attention-deficit/hyperactivity disorder (ADHD) is the official term and acronym used by today’s mental health care professionals, it is sometimes referred to by other names and abbreviations. For example, it is also called:
Attention deficit disorder (ADD)