| ADHD: Treatment with medications | 1998.00000000000 | ADHD: Treatment with medications | ADHD: Treatment with medications | A | English | Psychiatry | School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years) | Brain | Brain | Drug treatment | Caregivers
Adult (19+) | NA | | 2017-06-16T04:00:00Z | | Alice Charach, MD, MSc, FRCPC;Rosemary Tannock, PhD | | | | 10.0000000000000 | 54.0000000000000 | 1214.00000000000 | | Health (A-Z) - Procedure | Health A-Z | <p>Find out how medications can work with behavioural treatment to help a child with ADHD symptoms.</p> | <p>Medications are often an important part of the treatment plan for ADHD, but they are not recommended for pre-school age children.</p><p>On their own, medications can be very helpful in treating the core
<a href="/Article?contentid=1923&language=English">symptoms of ADHD</a>, but they often do not address the range of other possible problems that can contribute to poor functioning, such as irritability,
<a href="/Article?contentid=18&language=English">anxiety</a> and
<a href="/Article?contentid=1925&language=English">oppositional defiant disorder</a>. These other problems respond best to behavioural treatments in addition to medication.</p><p>Medications also cannot make up for any gaps in learning before a child started ADHD treatment. It is very important that children with ADHD get the
<a href="/Article?contentid=1999&language=English">right academic support</a> to help them reach their full potential.</p> | | <h2>Key points</h2>
<ul>
<li>Medications work well to treat the core symptoms of ADHD but work best with behavioural treatments for any related emotional, learning or behavioural issues.</li>
<li>In most cases, ADHD is treated with stimulants. Common, mild side effects include headaches, difficulty falling asleep, irritability and jitteriness. Rare but more serious side effects include allergies, severe agitation, heart problems and suicidal thinking.</li>
<li>Your child will be prescribed a low dose of medication that their doctor will monitor and adjust over time to make sure it continues working.</li>
<li>Your child’s doctor may change the dose schedule or recommend a "drug holiday" to minimize the side effects.</li>
</ul> | | | | | | | | | | | | | | | | | | | | | <h2>What types of medications treat ADHD?</h2>
<p>In most cases, ADHD is treated with stimulants. These have been widely used for ADHD for more than 40 years. They are effective for at least two-thirds of children with ADHD and have relatively few side effects.</p>
<h3>How stimulants treat ADHD</h3>
<p>Stimulants increase levels of brain chemicals called dopamine and norepinephrine. These chemicals affect a person’s mood, alertness, memory, level of attention and response to stress. Increasing the levels of these chemicals reduces inattention, hyperactivity and impulsivity. However, symptoms return as the stimulants wear off.</p>
<p>There is strong evidence to support the short-term benefits of stimulants for the core ADHD symptoms, but evidence for long-term benefits is more limited. As a result, it is important to monitor ADHD medications closely to make sure that they are still helpful for your child as they grow older. It is also common for ADHD symptoms to return when medications are stopped.</p>
<h2>Types of stimulants</h2>
<p>There are two main types of stimulant medications:</p>
<ul>
<li>methylphenidate</li>
<li>amphetamines</li>
</ul>
<p><em>Methylphenidate</em></p>
<p>The brands of methylphenidate that are available in Canada include:</p>
<ul>
<li>Biphentin</li>
<li>Concerta</li>
<li>Ritalin</li>
</ul>
<p><em>Amphetamines</em></p>
<p>The brands of amphetamines that are available include:</p>
<ul>
<li>Adderall XR</li>
<li>Dexedrine Spansule</li>
<li>Vyvanse</li>
</ul>
<p>Both types of stimulants come in pills or capsules that must be swallowed whole or capsules that can be opened and mixed with food.</p>
<h2>How long do stimulants last?</h2>
<p>Stimulants fall into two categories: short-acting and longer-acting.</p>
<h3>Short-acting stimulants</h3>
<p>These stimulants last for three to five hours. They start to take effect usually within 15 to 30 minutes of taking the first dose.</p>
<p>The effects of a stimulant taken first thing in the morning may start to wear off before lunchtime. If your child needs these medications for school, they will usually need to take at least one stimulant during the school day.</p>
<h3>Longer-acting stimulants</h3>
<p>Longer-acting stimulants last for eight to 14 hours. A child can take one dose in the morning and not need to take another dose at school. Longer-acting stimulants can also help children get through after-school activities.</p>
<p>The disadvantage of longer-acting stimulants is that they are sometimes slow to take effect and may interfere with sleep.</p>
<h2>How does my child's doctor know if the medication is working?</h2>
<p>Your child’s doctor will likely start your child on a small dose and gradually increase it until there is an effect on the target symptoms. The doctor might ask you and your child’s teacher to fill in rating scales at various doses of the stimulants to help them compare the effectiveness of different doses on your child's symptoms.</p>
<p>If the first stimulant does not have a positive effect or has too many side effects after a few doses, the doctor will try another stimulant. Children can react differently to medications, but most children will respond well to at least one of them.</p>
<p>If your child's symptoms still do not improve after trying three or more different medications, the doctor may reassess your child. It is possible that a diagnosis of ADHD may not be correct or that your child may have other conditions with ADHD.</p> | <h2>What are the side effects of stimulants?</h2>
<p>Methylphenidate and amphetamine have similar side effects, some of which are very common.</p>
<h3>Common side effects</h3>
<ul>
<li>Loss of appetite</li>
<li>Difficulty falling asleep</li>
<li>Stomach discomfort</li>
<li><a href="/Article?contentid=29&language=English">Headache</a></li>
</ul>
<h3>Less common side effects</h3>
<ul>
<li>Irritability, sadness</li>
<li>Subdued personality</li>
<li>Increased muscle tension</li>
<li>Rapid heart rate</li>
<li>Increase in blood pressure</li>
<li>Jitteriness</li>
<li>Social withdrawal</li>
</ul>
<p>Some of these side effects are temporary. Many can be relieved by reducing the dose or changing the dosing schedule. Taking the medication with food or a glass of milk can help to relieve stomach discomfort. </p>
<p><em>Weight loss and delayed growth</em></p>
<p>With long-term use, stimulants may cause weight loss and a slowing of growth for some children. Overall adult height may be reduced by up to 2 to 3 cm, especially in children taking high doses of stimulants without a break over a number of years. Your child's doctor should weigh and measure your child regularly while your child is taking stimulants.</p>
<h3>Rare but serious side effects</h3>
<p>These include:</p>
<ul>
<li>hypersensitivity or allergy</li>
<li>severe agitation and manic/psychotic symptoms</li>
<li>prolonged, painful erections in males (if this rare side effect lasts for more than four hours, take your child to a doctor urgently)</li>
<li><a href="/Article?contentid=291&language=English">suicidal thinking or behaviour</a></li>
</ul>
<h3>Very rare side effects</h3>
<p>Stimulants have been used safely in millions of children, but there have been very rare cases of severe cardiac events (such as heart attacks), including sudden death. In most of these cases, the child was later discovered to have had an underlying heart problem. Because of this, make sure to have your doctor do a complete review of your child’s health and medical history (including family history of heart problems) before prescribing stimulants. If there are any concerns your child may need to see a cardiologist (heart specialist) for further tests.</p>
<p>Many doctors recommend "drug holidays" to minimize side effects. These "holidays" are periods during which your child does not take stimulants, for instance during the summer or school holidays or on weekends. Your child’s doctor may recommend these breaks if your child functions reasonably well at those times without medication and there are concerns about your child’s weight gain or growth.</p>
<h2>Do stimulants lead to drug abuse?</h2>
<p>Stimulants are a controlled substance (their use is regulated by the government), which means they are prone to abuse by some people. Stimulants are not considered addictive or likely to increase the risk of substance abuse later in life, when they are used as prescribed to treat ADHD in children and teenagers.</p>
<h2>Can my child take stimulants with other medications?</h2>
<p>As with any prescription drug, stimulants can have potentially dangerous interactions with other medications. Discuss possible drug interactions with your child’s doctor by telling them about all the prescription medications, supplements and over-the-counter medications your child is currently taking.</p> | | | | | <h2>Further information</h2>
<p>For more information on ADHD, please see the following pages:</p>
<p><a href="/Article?contentid=1922&language=English">ADHD: Overview</a></p>
<p><a href="/Article?contentid=1923&language=English">ADHD: Signs and symptoms</a></p>
<p><a href="/Article?contentid=1997&language=English">ADHD: How to help your child at home</a></p>
<p><a href="/Article?contentid=1999&language=English">ADHD: Communicating with your child's school</a></p>
<h2>Resources</h2>
<p>The following resources offer support and additional information on ADHD.</p>
<h3>Websites</h3>
<p><a href="http://www.ldao.ca/" target="_blank">Learning Disabilities Association of Ontario</a></p>
<p><a href="http://www.caddac.ca/cms/page.php?2" target="_blank">Centre for ADHD Awareness, Canada - CADAC</a></p>
<h3>Journal articles</h3>
<p>Chang, Z., et al. (2014). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147667/">Stimulant ADHD medication and risk for substance abuse</a>. <em>J Child Psychol Psychiatr.</em> 55: 878–885. doi:10.1111/jcpp.12164.</p>
<p>Dalsgaard, Søren, et al. (2014). <a href="http://www.sciencedirect.com/science/article/pii/S0306460313002608?via%3Dihub" target="_blank">ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—a naturalistic long-term follow-up study</a>. <em>Addictive Behaviors</em> 39 (1): 325-328. doi:10.1016/j.addbeh.2013.09.002.</p> | | | https://assets.aboutkidshealth.ca/AKHAssets/ADHD_treatment_with_medications.jpg | | | | | | | ADHD: Treatment with medications | | | | |
