ADHD medications
Introduction
The purpose of this tool is to help you decide whether ADHD medication is right for your child. When making a decision like this, you must balance:
- The reasons for taking the medication
- The potential health risks, side effects, or limitations of the medication
- Whether there are alternative treatments that may be more appropriate
- Cost
This tool is not a substitute for professional medical care and advice. Work with your child's doctor to help you make this decision. A second opinion from another doctor may be valuable. Medication always has potential side effects, and you should be fully informed about the risks and benefits of this type of medication. There is usually no exact "right" or "wrong" answer.
Your child's doctor may make certain recommendations to you. However, the final decision about whether to use this medication rests with you.
What is the medication?
ADHD (attention deficit hyperactivity disorder) is when a child has trouble with attention, over-activity, or impulsiveness. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development.
The American Academy of Pediatrics has these guidelines:
- Set specific treatment goals.
- Start medication and behavior therapy.
- When treatment does not meet the goals, make sure the child really has ADHD, check for other conditions, and consider how well the treatment plan was implemented.
- Have regular follow-up appointments to check the results of treatment, and evaluate any side effects of medications.
Children who receive both behavioral treatment and medication often do the best. However, medications should not be used just to make life easier for the parents or the child's school.
Several different classes of ADHD medications are now available and may be used alone or in combination. This tool will focus on first-line stimulant medications. Other medications for ADHD are not recommended as initial treatments and should be discussed with your child's doctor.
Key points
If your child has -- or you suspect your child has -- ADHD, you should consider the following:
- Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed.
- There is considerable controversy about whether there may be over-treatment of children who display problems with attention, impulsivity, hyperactivity, and trouble in school.
- Your child's doctor should confirm that your child meets criteria for having the disorder. Your child should have six or more symptoms of hyperactivity, inattention, and impulsivity that impair the ability to function in at least two settings (for example, home and school) for at least 6 months.
- Failure to accurately assess your child's symptoms -- in duration, severity, impairment, and whether another problem like anxiety or family conflict is a possible cause -- could cause your child to be incorrectly diagnosed with, and receive medication for, ADHD.
- If, however, your child does meet the diagnostic criteria for ADHD, delaying treatment could result in your child falling further behind in school.
- Stimulant medications are the first choice of treatment for ADHD. These include methylphenidate (Ritalin and Concerta) and dextroamphetamines (Dexedrine and Adderall).
- These medications should be part of a comprehensive management plan. This plan must include the doctor consulting with your child's teachers and other adults who work with the child. You and the doctor should set developmentally appropriate goals and closely monitor the child's treatment plan.
- You may want to consider a brief trial of medication treatment. Have your child's teacher evaluate the child during two separate weeks. Do not tell the teacher which week the child was taking medication. This can help you assess if medication has or has not helped your child.
- Second-line medications include antidepressants [imipramine, desipramine, atomoxetine (strattera), and clonidine]. Imipramine, desipramine, and atomoxetine can decrease inattention and hyperactivity. Strattera may increase suicidal thoughts in adolescents. Clonidine has shown some benefit, but stimulants seem to work better. These medications are not recommended for first-line treatment.
How much time this decision tool will take
5 - 10 minutes
What this tool will provide
- A personalized list of factors for you to weigh
- Questions to ask your doctor
- Alternatives to this medication
- Recommended reading
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
- Hechtman L, Abikoff H, Klein RG, Greenfield B, Etcovitch J, Cousins L, Fleiss K, Weiss M, Pollack S. Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: impact on parental practices. J Am Acad Child Adolesc Psychiatry. 2004 Jul;43(7):830-8.
- Management of attention deficit hyperactivity disorder: a parental perspective. Journal of Pediatrics & Child Health. 2005 Dec;41(12):625-30.
- Parental perceptions and satisfaction with stimulant medication for attention-deficit hyperactivity disorder. Journal of Developmental & Behaviour Pediatrics. 2003 Jun;24(3):155-62.
- Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921.
- Rappley MD. Clinical practice. Attention deficit-hyperactivity disorder. N Engl J Med. 2005 Jan 13;352(2):165-73.
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