A Parent’s Complete Guide to ADHD Medications
Everything you need to know to help your child find the right ADHD medication — by learning how medications work, monitoring their effectiveness, and knowing when to switch to another medication if your child isn’t getting the best results.
Get the Right Diagnosis (and Treatment) for Your Child
The numbers tell the story: according to the Centers For Disease Control, 6.4 million children ages 4-17 have been diagnosed with ADHD. The good news is that there are safe, effective treatments for the disorder. According to the American Academy Of Pediatrics, the most effective treatments for ADHD are parental behavior therapy and/or ADHD stimulants for children over age six. Experts know, from years of research and many studies, that ADHD stimulants work. They improve the core symptoms of ADHD — impulsivity, hyperarousal, and distractibility — in some 70-80 percent of the people who take them.
Nail Down the Diagnosis
Getting the correct diagnosis is the foundation of successful treatment. A faulty diagnosis leads to treatments that don’t improve symptoms or, in some cases, make them worse. Doctors frequently mistake ADHD for other disorders, so it is important that your doctor use all the tools available to assess your child.
Diagnosis should include the following steps: taking a medical history to rule out physical causes of the symptoms; meeting the symptom guidelines of ADHD in the DSM-5; interviewing parents, teachers, and guardians about a child’s behaviors; filling out rating scales to compare your child’s behaviors with the normative average; and assessing for co-occurring conditions, such as anxiety, learning disabilities, and others. Studies suggest that 70 percent of children diagnosed with ADHD have one or more co-occurring conditions.
Medication and Dose
When you and your child’s doctor are confident of the diagnosis, and you decide to start your child on medication, understand that you must work closely with your doctor to find the optimal medication and dose. There are two classes of stimulants — methylphenidate and amphetamine. Every child has a biological preference for one or the other classes, but it is only through trial and error — taking methylphenidate and then, in separate trial, taking amphetamine — that a doctor can determine which one will work best for your child. Stimulants do not work for 20-30 percent of people diagnosed with ADHD. When they don’t, a doctor will consider using a nonstimulant medication to improve symptoms.
[Free Download: 13 Questions to Ask Before Starting Any ADHD Medication]
The optimal dose of ADHD stimulant is not determined by age, weight, gender, or severity of symptoms. It is determined by three factors that are unique to each individual: how efficiently the medication is absorbed in the GI tract, how efficiently the medication is metabolized, and how efficiently the medication passes across the blood-brain barrier.
Experts agree that the right dose of stimulant will change as your child grows. The American Academy of Pediatrics recommends adjusting a child’s dose once a year to achieve symptom management. After age 16, a person usually settles into an optimal dose, which, in most cases, does not change for the rest of a person’s life.
When thinking about starting a child on ADHD medication, it is key that a parent know what to expect from various medication choices and what to do when the medication doesn’t produce positive results. (“Understanding ADHD Medications” will give you an easy-to-understand overview of the process of using ADHD medications.)
How to Monitor a Medication’s Effectiveness
After your child has started taking ADHD medication, you want to make sure that symptoms are improving without side effects — mood changes, headaches, nausea, poor appetite, and so on. Monitoring your child’s behavior and physical symptoms is key to knowing when a medication is working and when it isn’t. (The best tools for monitoring medication are the “Parent Home Medication Log” and the “Teacher Observation Log.” You will find both in our free downloadable guide at additu.de/med-guide.) You are your child’s best advocate in the process, especially for younger kids who can’t articulate what they are feeling.
Remember that the optimal dose for your child at age six or seven will probably need to be adjusted as he or she makes his or her way from elementary to middle school to high school. Hormonal changes, as a child approaches puberty, alter the effectiveness of ADHD medication.
[How Does ADHD Medication Work? With Lots of Monitoring]
Below are the most common signs that a medication is doing what it should. You may notice other signs unique to your child’s specific challenges. If you’re not sure which improvements to look for in your child, stick to these guidelines. If you see them (even if some side effects remain), you are on the way to optimizing the medication’s effectiveness.
1. Sustained focus. If the medication is starting to work, your child will be able to focus for longer periods of time than he used to. This doesn’t mean hyperfocus or “zombie focus” — just a sustained focus that he can direct to where he wants it to go, and that makes him more productive.
2. Less impulsivity. If your child’s medication is working, you’ll notice less impulsivity — both physical and verbal. He will interrupt people or jump out of his seat less often. Your child will notice that her thoughts are less impulsive, too — she is less distracted by “brain chatter.”
3. Improved mood. When ADHD medication is optimized, a child typically has an improved overall mood. He is less stressed, with less anxiety — usually shown by higher productivity and fewer social challenges.
4. Greater attention to detail. Details become more important — instead of skipping a step in a math problem, your child will catch small mistakes before they happen.
5. Better memory. Some patients report improved memory once they start taking ADHD medication. They can remember people’s names more easily, and don’t need to re-read the chapter of the book they read last night.
6. Better sleep. Sleep problems are a common side effect of ADHD medication. But, in some cases, treatment helps children and adults with ADHD fall asleep; the right medication can slow down their brains enough to quiet the racing thoughts that used to keep them awake.
Troubling Signs and Common Side Effects
What’s the most obvious sign that a medication isn’t working? Your child isn’t feeling any of the positive effects mentioned above. But even if your child is feeling some of them, the medication might not be perfect. Your child might not feel the benefits as consistently or as strongly as you would like, or he might be dealing with some uncomfortable side effects.
[The 5 Most Common Med Side Effects — and Their Fixes]
Most people know when they’re experiencing unpleasant side effects, but some problems — especially in younger children — may slip by. Ask your doctor to check for the most common side effects — nausea, appetite loss, irritability, sleeplessness, and headaches — so you know what to look for. You should also ask your doctor to explain the rare side effects that can be dangerous, like shortness of breath, allergic reactions, and heart problems.
Solutions to Common Medication Problems
If your child isn’t getting all the benefits from ADHD medication that you had expected, and is also experiencing side effects, there are five common explanations for the problem. Talk with your doctor about your child’s problems and, between the two of you, you will be able to solve them.
Wrong medication. If your child is taking the wrong medication, you may see some benefits — sustained focus, less impulsivity, improved mood, and so on — but they’ll be faint, and negative side effects will outweigh them by a considerable degree. Is your child more irritable than normal? Does he have a headache that won’t go away? Is he sleeping worse than before? If you answer yes to any of these questions, it might be that your child is taking the wrong medication. If so, talk with your doctor about switching to another.
Generic versus brand name. By law, a brand-name medication can vary in its potency by only 1 percent, high or low, from pill to pill. A generic formulation of the medication can vary in potency between 20 percent low and 25 percent high from pill to pill. The larger the tablet or capsule size, the greater the potential variability. People who are very sensitive to dose find it hard to tolerate this much variability. Patients come in wanting stability and predictability in behavior, emotions, school or work performance, and sleep. Formulations that fluctuate a lot from pill to pill do not support these goals.
If you switch medications due to insurance requirements, and find that your previous medication was more effective, talk with your doctor. In most cases, she will be able to work with your insurance company to get you back on your previous medication.
Wrong dose. Some parents tell their doctor that the medication is working for their child, but the gains aren’t big enough to make a difference in her life. If this describes your child, she might be taking the wrong dose. The medication dose may be too low, since prescribers start at the lowest recommended dose and increase it from there. But everyone responds to medication differently, and even a “low dose” might be too much for your child’s particular brain and body. If you feel like her medication is helping, but could be doing more, talk with your doctor about adjusting her dose.
Wrong time. Your child could be taking medication too early, too late, or at an incorrect frequency. If it is taken too early, it wears off before you want it to. If it is taken too late, it doesn’t kick in by the time he needs it.
If it is being taken at the wrong frequency — only once a day, for instance, instead of multiple doses — its coverage will be inconsistent. If different times of day have different focus needs, ask your doctor about medication combinations. Perhaps your child needs a long-acting pill in the morning and a short-acting pill in the evening to keep his focus level steady throughout the day.
Interactions. While most medications interact well with those used to treat ADHD, there are a few exceptions. You shouldn’t take ascorbic acid or Vitamin C an hour before or after you take ADHD medication. ADHD stimulants are strongly alkaline, and cannot be absorbed into the bloodstream while these organic acids are present. High doses of Vitamin C (1000 mg), in pill or juice form, can accelerate the excretion of amphetamine in the urine and act like an “off switch” on the med. Caffeine is another culprit. It’s also a stimulant, and many people with ADHD “self-medicate” with caffeine. Once you start taking an ADHD medication, you may find that the amount of caffeine you used to tolerate easily now makes you jittery and anxious.
How to Work With Your Doctor to Make a Medication Change
As a parent, you know your children best. You know their favorite foods and which ones they should stay away from. You know when they are getting sick or when a tantrum is brewing. Often you can tell when they are lying or in need of extra attention.
But what happens when you have to rely on someone else’s expertise to figure out the best ADHD medication management strategies for your child? When you are wondering if the medication your child is taking is really the best one for him? Or you have not been seeing the positive changes you were told to expect, or your child is experiencing a side effect that troubles you?
You can’t go it alone. You need to rely on the expertise of your child’s medication prescriber to determine the best medication for him. How do you communicate with the doctor so that you are heard? When you are the expert on your child, and the doctor is the expert on ADHD medication, here are five things to keep in mind:
Doctors want to find the best medication for your child. Medically speaking, a doctor’s repertoire of treatment strategies is typically limited to prescribing medication. Working with you to find the right medication, dosage, and administration schedule means she has done her job.
Doctors depend on you. Because you know your child best, prescribers rely on you to report any improvements or negative side effects that your child is experiencing. Doctors use this information to determine the next change to make in adjusting medication, whether it’s changing the dose or changing to another medication.
Keep track of what you observe. One of the first things a doctor will ask during a follow-up medication check appointment is, “How is the medication working?” Telling the doctor how your child is sleeping or eating is just the tip of the iceberg in providing information that is needed to find the best medication. Using a medication log will help you capture key information. For instance, noting when your child takes the medication and when it wears off are important to guide medication adjustments. Asking his teacher to track his behaviors at school will provide important information needed to assess the effectiveness of a medication.
Ask your child. Before you meet with the prescriber for a medication effectiveness appointment, ask your child for feedback about her experience of taking the medication. Ask: “What do you notice is different for you when you take the medication? When do you notice the medication starting to work after you take it? What do you notice when the medication is wearing off? If anything were possible, what else would you want the medication to help make different?” Don’t forget that the key person in this equation is the child, and she has an important perspective to share — how the medication is working for her. In addition, during the medication adjustment appointment, invite your child to answer the questions asked by the doctor. It is probably more efficient for you to answer in our time-conscious medical system; however, your child’s voice and involvement in the process are invaluable.
Determine if your doctor knows her stuff about ADHD and medication. At a time when more people are being diagnosed with ADHD, and awareness of ADHD is growing, the fact remains that many doctors have had little training in diagnosing ADHD or in evaluating ADHD medications in medical school. Those doctors who are familiar with ADHD and the medications that treat it are often those who have taken it upon themselves to learn. So how do you find out if your doctor or medication prescriber is someone who has the medical expertise needed? Asking lots of questions will give you a basic idea of how qualified he or she is: what type of medication is this? Stimulant or nonstimulant? How does this medication work in my child’s brain? How does it help his ADHD? And so on.
Following our guidelines will make sure that you will have all the essential information and people on your team to determine the right category, dose, and timing of the ADHD medication — and to maximize your child’s chances of safely getting all the benefits that ADHD medications can deliver.
ADHD Medication Options
ADHD stimulants come in two classes — methylphenidate and amphetamine — which are then further broken down into specific types. Each class comprises a variety of formulations, each with its own way of working in the brain, duration of action, and dosage options. Here is a short list of medications from each of the stimulant classes, and a few from the nonstimulant classes. Click on each medication’s name to read a full overview, treatment reviews, and more — or visit this chart to directly compare different types of medications.
METHYLPHENIDATE
Aptensio XR® (Rhodes Pharmaceuticals)
Extended-release capsule
10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg
Concerta® or generic (Janssen and others)
Extended-release tablet
18 mg, 27 mg, 36 mg, 54 mg
Cotempla XR-ODT (NEOS Therapeutics)
Extended-release orally disintegrating tablet
8.6 mg, 17.3 mg, 25.9 mg
Daytrana® (Noven Therapeutics)
Transdermal patch
10 mg, 15 mg, 20 mg, 30 mg
Metadate CD® (UCB, Inc.)
Extended-release capsule
10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg
Methylphenidate HCI (Lupin)
Chewable tablet
2.5 mg, 5 mg, 10 mg
Methylphenidate HCl (Mallinckrodt Pharmaceuticals)
Extended-release tablet*
10 mg, 20 mg
Methylin™ Liquid or generic (Shionogi Pharma, and others)
Oral solution
5 mg/5 mL, 10 mg/5 mL
Quillichew ER™ (Pfizer)
Extended-release chewable tablet
20 mg, 30 mg, 40 mg
Quillivant XR® (Pfizer)
Extended-release oral suspension
25 mg/5 mL
Ritalin® or generic (Novartis and others)
Short-acting, immediate release tablet
5 mg, 10 mg, 20 mg
Ritalin LA® (Novartis)
Extended-release capsule
10 mg, 20 mg, 30 mg, 40 mg, 60 mg
Ritalin SR® (Novartis)
Sustained-release tablet
20 mg
DEXMETHYLPHENIDATE
Focalin® or generic (Novartis and others)
Short-acting, immediate-release tablet*
2.5 mg, 5 mg, 10 mg
Focalin XR® or generic (Novartis and others)
Extended-release capsule
5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg
AMPHETAMINE
Adzenys ER™ (Neos Therapeutics)
Extended-release oral suspension
1.25 mg/ml
Adzenys XR-ODT™ (Neos Therapeutics)
Extended-release orally disintegrating tablet
3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, 18.8 mg
Dyanavel® XR (Tris Pharma)
Extended-release oral suspension
2.5 mg/mL
DEXTROAMPHETAMINE
Dexedrine® (Amedra Pharmaceuticals and others)
Short-acting tablet
5 mg, 10 mg
Dexedrine ER® (Amedra Pharmaceuticals and others)
Extended-release spansule
5 mg, 10 mg, 15 mg
ProCentra® and generic (Independence Pharma, Tris Pharma, and others)
Oral solution
5 mg/5 mL
Zenzedi® (Arbor Pharmaceuticals)
Immediate-release tablet
2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg
METHAMPHETAMINE
Desoxyn® (Recordati Rare Diseases and others)
Immediate-release tablet
5 mg
MIXED AMPHETAMINE SALTS
Adderall® or generic (CorePharma and others)
Short-acting, immediate release tablet
5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg
Adderall® XR or generic
Extended-release capsule
5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Mydayis® (Shire Pharmaceuticals)
Long-acting capsule
12.5 mg, 25 mg, 37.5 mg, 50 mg
AMPHETAMINE SULFATE
Evekeo® (Arbor Pharmaceuticals)
Immediate-release tablet
5 mg, 10 mg
LISDEXAMFETAMINE
Vyvanse® (Takeda Pharmaceutical Company)
Long-acting capsule
10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
Vyvanse® (Takeda Pharmaceutical Company)
Chewable tablet
10 mg, 20 mg, 30mg, 40 mg, 50 mg, and 60 mg
ATOMOXETINE
Strattera® (Lilly)
Long-acting capsule
10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg
CLONIDINE
Kapvay® (Concordia Pharmaceuticals)
Extended-release tablet
0.1 mg, 0.2 mg
GUANFACINE
Intuniv™ or generic
Extended-release tablet
1 mg, 2 mg, 3 mg, 4 mg
BUPROPION
Wellbutrin XL® (Valeant Pharmaceuticals)
