ADHD: Treatment with medications

By SickKids staff

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Find out how medications can work with behavioural treatment to help a child with ADHD symptoms.

Key points

Medications work well to treat the core symptoms of ADHD but work best with behavioural treatments for any related emotional, learning or behavioural issues.
In most cases, ADHD is treated with stimulants. A common, mild side effect is a decreased appetite at lunchtime, followed by irritability when the medication 'wears off' after school. This side effect commonly responds to a favourite snack after school. Less often, there may be difficulty falling asleep when the medication is first started.
Serious side effects are extremely uncommon. These medications, when prescribed appropriately, are very safe.
Your child will be prescribed a low dose of medication that their health-care provider will monitor and adjust over time to make sure it continues working.

Introduction

Treatment

What types of medications treat ADHD?

In most cases, ADHD is treated with stimulants. These have been widely used for ADHD for more than 50 years. They are effective for at least 80 per cent of children with ADHD and have relatively few side effects.

How stimulants treat ADHD

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 in the late afternoon or evening.

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. Recently, however, research indicates that during periods of time on their ADHD medication, teens are less likely to have self-harm behaviour, substance use, fractures, motor vehicle collisions or police involvement. 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.

Types of stimulants

There are two main types of stimulant medications:

methylphenidate
amphetamines

Methylphenidate

The brands of methylphenidate that are available in Canada include:

Biphentin®
Concerta®
Foquest®
Ritalin®

Amphetamines

The brands of amphetamines that are available include:

Adderall XR®
Dexedrine Spansule®
Vyvanse®

Both types of stimulants come in pills or capsules that must be swallowed whole or capsules that can be opened and mixed with food.

How long do stimulants last?

Stimulants fall into two categories: short-acting and longer-acting.

Short-acting stimulants

These stimulants last for three to five hours. They start to take effect usually within 15 to 30 minutes of taking the first dose.

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.

Longer-acting stimulants

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.

The disadvantage of longer-acting stimulants is that they are sometimes slow to take effect and may interfere with sleep.

How does my child's health-care provider know if the medication is working?

Your child’s health-care provider will likely start your child on a small dose and gradually increase it until there is an effect on the target symptoms. The health-care provider 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.

If the first stimulant does not have a positive effect or has too many side effects after a few doses, their health-care provider will try another stimulant. Children can react differently to medications, but most children will respond well to at least one of them.

If your child's symptoms still do not improve after trying three or more different medications, their health-care provider 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.

More information about the treatment

What are the side effects of stimulants?

Methylphenidate and amphetamine have similar side effects, some of which are very common.

Common side effects

Loss of appetite
Difficulty falling asleep when the medication is taken too late in the day

Less common side effects

Irritability, sadness—overall, research shows that treatment improves quality of life. Irritability or sadness at the end of the day may simply reflect that your child is "hangry" because of the mid-day appetite suppressant effects of the medication. Giving your child their favourite snack often solves this problem.
Subdued personality—treatment reduces impulsivity and improves emotional regulation, which may give the appearance that your child is subdued, but this may simply reflect the difference between ADHD behaviours and more "normal" behaviour.
Increase in blood pressure—blood pressure typically only increases by a very small amount (5 mm of Hg) if it increases at all.
Social withdrawal—children who are less social by nature, and whose attention spans improve with treatment, may retreat into their preferred activities. However, good research shows that overall, these medications improve relationships with peers, parents/caregivers and teachers.

Some of these side effects are temporary. Many can be relieved by reducing the dose or changing the dosing schedule.

Weight loss and delayed growth

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 in 3 per cent of children, especially in children taking high doses of stimulants without a break over a number of years. However, 97 per cent of children appear to have no effect on their ultimate height. Your child's health-care provider should weigh and measure your child regularly while your child is taking stimulants.

Very rare but serious side effects

These include:

hypersensitivity or allergy
severe agitation
prolonged, painful erections in males (if this rare side effect lasts for more than four hours, take your child to a health-care provider urgently)

Other considerations

Stimulants have been used safely in millions of children. However, there have been very rare cases of severe cardiac events (such as heart attacks), including sudden death, but it is difficult to know if the medication contributed. In most of these cases, the child was later discovered to have had an underlying heart problem. In a recent review of data from poison control centres from across the USA over a 10-year period, there were no deaths among children who had accidentally taken more than their prescribed dose of ADHD medication. Nevertheless, make sure to have your child's health-care provider 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.

Do stimulants lead to drug abuse?

Stimulants are a controlled substance (their use is regulated by the government), which means they are prone to abuse by some people. However, recent data indicates that treatment of ADHD with stimulant medication actually REDUCES the risk of substance use. 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.

Can my child take stimulants with other medications?

As with any prescription drug, stimulants can have interactions with other medications. Discuss possible drug interactions with your child’s health-care provider or with a pharmacist by telling them about all the prescription medications, supplements and over-the-counter medications your child is currently taking.

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Last updated: February 20th 2024