What are the medications used in treatment of ADHD?
Medications used to treat ADHD are broadly divided in two groups:
- Stimulants like methylphenidate and dexamphetamine
- Non stimulants like atomoxetine.
Stimulants have the effect of making people feel more alert, energetic, and awake. In a person suffering ADHD, they can improve attention and reduce hyperactivity. The stimulants used in the treatment of ADHD include methylphenidate (previously commonly known by the name ‘ritalin’) and dexamphetamine.
Methylphenidate is available as different forms. Immediate release methylphenidate is short-acting. It is used for its flexibility in dosing and can be used to determine the correct level of dose during dose changes. Slow or modified release methylphenidate work for 8 – 12 hours and can be given once a day. They are more convenient, and as the child or young person need not take a dose in school, reduces stigma attached to this disorder.
Non stimulant medications by nature do not make people alert or active. However, in ADHD, they can improve symptoms of inattention and hyperactivity. These include medications like atomoxetine.
Sometimes other medications may be used to help with problems with sleep and challenging behaviours that are associated with ADHD.
How do they work?
Medications act on certain chemicals in the brain called ‘noradrenaline’. They seem to affect the parts of the brain that control attention and organise our behaviour.
They do not cure ADHD. They help to control the symptoms of poor attention, overactivity or impulsivity.
Which medication will be used for my child?
Stimulant medication methylphenidate is usually prescribed first. The type of stimulant prescribed will depend on a number of things like the symptoms your child has, your choice of treatment, the ease of giving the medication and even availability/cost of the medication.
If methylphenidate causes unpleasant side-effects or does not work, other stimulant (dexamphetamine) or non stimulant medications may be prescribed. Sometimes a child may respond to a different form of methylphenidate.
How do I know it is working?
You will find that:
- your child’s concentration is better
- their feelings of restlessness or over-activity are less
- they control themselves better.
Sometimes school or teachers notice the improvement before you do.
What are the side-effects?
As with most medications, there may be some unwanted effects. However, not everyone gets side effects and most side effects are mild and disappear with continued use. Side effects are less likely if the dose is increased gradually when the tablets are started. Some parents worry about addiction, but there is no good evidence to suggest that this is a problem.
Some of the common side effects of methylphenidate include:
- loss of appetite
- difficulty falling asleep
- light headedness
Less common side effects to look out for include:
- being ‘over-focused’, quiet and staring- this may be a sign that the dose is too high
- anxiety, nervousness, irritability or tearfulness
- tummy pains or feeling sick
- headache, dizziness or drowsiness
- tics or twitches.
In the long term, sometimes growth slows down when children are on methylphenidate. Research shows that the total adult height may be reduced by 2.5 cm when on methylphenidate.
This list of side-effects is not exhaustive. If you notice anything unusual, it is important to contact your doctor immediately.
Is there anything I need to know before giving the medication?
Before you give any medication do tell your doctor about:
- allergies your child might have
- any other medicines they take, including vitamins or supplements
- for older girls if they are likely to become pregnant
- if you or anyone in your family suffers from physical health problems, especially high blood pressure, heart problems and repeated movements (called tics).
Are there any special tests before or while taking the medications?
Before taking the medication, your child should be physically checked up especially for their heart rate, blood pressure, growth and any other medical problems. Sometimes they may need blood test or heart tracing test to measure the electrical activity of the heart called an electrocardiogram (ECG).
While taking the medication, your doctor will monitor your child’s heart rate, blood pressure, weight and height on a regular basis along with checking for any side effects.
What do I need to know about giving the medication?
Some helpful things to know:
- Give the medication at the times you were told by your doctor or pharmacist
- Keep appointments for regular review of medication
- Store the medication safely
- Ensure your child swallows the medication, not chew or crush it
- Make sure your child drinks enough, especially in hot weather and while exercising.
- Double the dose if they miss a dose of medication
- Stop giving the medication without discussing with the doctor
- Give the medication to anyone else, even if you feel their difficulties are similar to your child’s.
How long do they need to be on the medication?
Most children and young people need the medication at least until they finish their education or schooling. A few might need to take it even when they grow up. Some children need medications only at specific times, like for example while attending school, and do not have to take it on weekends or on school holidays.
Your doctor would regularly check, at least once a year, if they need to continue the medicine.
Taking these medications can affect driving, and even certain careers like joining the army. It is important that the child is aware this and will need to discuss it with their doctor as they grow up.
Young people may need explanations and support as they grow up about taking their medication. Stopping medication can cause symptoms to return, and some young people can put themselves at risk in terms of their education, their work, and socially by being impulsive and taking alcohol or drugs.
Remember: if you have any further questions regarding this medication, do not hesitate to contact your doctor or pharmacist.