Kids with attention deficit hyperactivity disorder (ADHD) may have more trouble focusing, paying attention, controlling their impulses, and sitting still than those without it. This is because their brains work differently from those of kids without ADHD: They develop more slowly and have fewer chemical messengers like dopamine and norepinephrine to relay the signals that regulate behavior and emotion.
Stimulant and non-stimulant ADHD medications work by increasing levels of these chemicals.
Medicine is just one part of an ADHD treatment strategy. The American Academy of Pediatrics recommends treating children ages 6 and older with a combination of medication and behavioral therapies.
Every child is unique and responds differently to treatment. Getting on the right medicine can take time. Your child may need to try a few medicines and doses to find what works best for them.
Medications to Manage ADHD Symptoms
ADHD medicines are only available with a doctor's prescription. They come in two forms: stimulant and non-stimulant.
Stimulant medicines
Doctors most often prescribe these medicines first for children with ADHD, because stimulants often work better than non-stimulant medicines. Stimulant medicines increase levels of the brain chemicals dopamine and norepinephrine, which affect a child's ability to focus and concentrate.
ADHD stimulants come in many forms, including:
- Pill
- Liquid
- Chewable
- Patch
- Capsules that your child can swallow or take mixed in with food
Stimulants come in two types of doses: immediate-release (short-acting) and extended-release (intermediate- and long-acting). Each type manages ADHD symptoms for a different length of time.
Most stimulants are in one of two drug classes based on their ingredients:
- Methylphenidate, which includes Focalin and Ritalin, has been around the longest. There's a lot of research to show that it helps most children with ADHD.
- Amphetamine has also been in use for many years, and good evidence also confirms that it works well.
Immediate-release (short-acting). Your child takes this medicine when they need it; for example, before school. Immediate-release medicines start to work quickly, and their effects last for three to six hours.
Examples of short-acting stimulants are:
- Amphetamine: Adderall, Desoxyn, Dexedrine, Dextrostat, Evekeo, Evekeo ODT, Zenzedi
- Methylphenidate: Focalin, Methylin, Ritalin
Intermediate-release (intermediate- or long-acting). Children usually take immediate- or long-acting formulations in the morning. The medicine has a sustained effect that helps kids get through the school day without needing an extra dose. The effects of intermediate-acting stimulants last for eight to 10 hours. Long-acting stimulants keep working for 10 to 12 hours.
Examples of intermediate-acting stimulants are Metadate CD and Ritalin LA (methylphenidate).
Long-acting stimulants include:
- Amphetamines: Adderall XR, Adzenys ER, Dexedrine, Dyanavel XR, Mydayis, ProCentra, Vyvanse
- Methylphenidate: Adhansia XR, Aptensio XR, Azstarys, Concerta, Cotempla XR, Daytrana, Focalin XR, Jornay PM (for night-day use), Metadate ER, Quillichew ER, Quillivant XR
Doctors often prescribe older medicines like Adderall or Ritalin first. There's more research to show that these medicines work, and they're usually less expensive than newer ADHD drugs. Older medicines are also more likely to be covered by insurance.
Non-stimulant medicines
These medicines are an option for children who can't take stimulants or who don't improve on a stimulant. Non-stimulant medicines increase levels of norepinephrine in the brain.
Examples are:
- Atomoxetine (Strattera)
- Alpha agonists: clonidine (Kapvay) and guanfacine (Intuniv)
- Viloxazine (Qelbree)
Non-stimulants keep working for up to 24 hours after kids take them, but they're slower to take effect. Your child may need to be on a non-stimulant for three to four weeks before they have any symptom improvement.
These medicines tend to work best when taken at the same time each day. If your child feels sleepy while on them, ask the doctor about switching to nighttime dosing.
Some children take a combination of long-acting and short-acting stimulants. They take a long-acting medicine in the morning to get them through the school day, and then a short-acting medicine to help them focus during an after-school program or while doing homework.
Antidepressants
These medicines aren't approved for ADHD, but doctors sometimes prescribe them for that purpose. Antidepressants called norepinephrine-dopamine reuptake inhibitors increase levels of norepinephrine and dopamine in the brain. Tricyclic antidepressants are older medicines that are sometimes used for ADHD.
Examples of antidepressants for ADHD are:
- Norepinephrine-dopamine reuptake inhibitors: bupropion hydrochloride (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
- Tricyclic antidepressants: desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor)
Section summary
Types of ADHD medications:
Stimulants
- Are most the most commonly prescribed ADHD medication
- Work quickly and are more effective for most children
- Work by raising levels of dopamine and norepinephrine in the brain
- Can be short-acting (three to six hours) or intermediate/long-acting (eight to 12 hours)
Non-stimulants
- Are used if stimulants don't work or if they cause side effects
- Work more slowly (three to four weeks to see effects)
Antidepressants
- Are sometimes used off-label, especially when other options fail
- Two types: norepinephrine-dopamine reuptake inhibitors and tricyclic antidepressants
Which ADHD Medicine Is Best?
The doctor will prescribe a medicine, dose, and schedule for your child based on:
How long it lasts. Does your child just need it to get through the school day, or to last during after-school activities and homework, too?
The effects. Is the dosage high enough to relieve symptoms without causing side effects?
Availability. There has been a shortage of immediate-release Adderall, which has led doctors to prescribe other medicines instead.
It could take some trial and error to find the medicine and dose that work for your child and don’t cause side effects. The doctor will schedule regular checkups to see if the medicine is working and make adjustments as needed.
For best results, your child should take the exact dose of the medicine their doctor prescribed at the same time each day. If side effects happen, don't just take your child off the medicine. Instead, ask the doctor about next steps.
ADHD Medicine Side Effects
Most side effects from ADHD medicines are mild. They often happen soon after children start taking the medicine and should improve as their body gets used to the drug. Only rarely do kids have severe side effects from these medicines.
The most common side effects of stimulant drugs are:
- Reduced appetite (About 80% of children have this problem.)
- Weight loss
- Sleep problems (taking longer to fall asleep and having trouble falling asleep)
- Crankiness
- Headache
Short-acting stimulants can cause a "crash" when they wear off, with symptoms like extreme hunger, tiredness, and moodiness.
Other possible side effects include:
Tics. Stimulant medicines don't cause these sudden, repeated movements or sounds. Tic disorders are just more common in children with ADHD. But there is a very slight chance the medicine could make tics worse if your child has them already.
Slow growth. Some children grow a little more slowly than usual while taking stimulants. Any slowing shouldn't last long. Kids who take these medicines aren't any shorter than their peers when they grow up.
Nausea and vomiting.
Stomachache.
Anxiety.
Stimulant drugs might raise blood pressure and heart rate a little bit. This usually isn't dangerous, but the doctor may order an electrocardiogram (EKG) to check your child's heart rhythm before prescribing one of these medicines. Tell the doctor if your child has heart problems, or if there is a family history of heart problems or abnormal heart rhythms. The doctor may need to watch your child's heart and blood pressure more closely during treatment with stimulants.
It's possible to become dependent on stimulant medicines. This leads some people to misuse or abuse these drugs. The government considers stimulants to be controlled substances and closely regulates them. But these medicines are safe when a doctor prescribes them and children use them the right way.
Non-stimulant drugs are less likely to cause dependence, but they can cause side effects like these:
- Tiredness
- Sleepiness
- Upset stomach
- Dizziness
- Reduced appetite
- Mood swings
- Changes in heart rate or blood pressure
Strattera comes with the FDA's most serious warning, known as a black box warning. This is because in rare cases, the drug has increased the risk of thoughts of suicide in children and teens. It's important for you and your doctor to be alert for these types of thoughts if your child takes Strattera.
If side effects don't improve and your child can't tolerate the medication, the doctor might lower the dose or prescribe a different type of ADHD medicine.
These side effects are more serious. Get emergency medical help right away if your child has:
- A pounding heartbeat
- Chest pain
- Shortness of breath or trouble breathing
- Fainting
- Numbness or weakness
- Swelling of the face
- Hives
Questions to Ask Your Doctor
A psychiatrist, pediatrician, or primary care doctor will prescribe ADHD medicines and monitor your child while they’re on them. It's important to find a doctor who you and your child feel comfortable with and trust.
It's helpful to understand any medicine your doctor prescribes for your child, including how it works and what side effects it might cause. Here are some questions to ask your doctor when they prescribe any new medication:
- Why did you recommend this medicine?
- How does it work in the brain? Is it a stimulant or non-stimulant?
- What are the alternatives?
- How much does it cost, and will our insurance cover it?
- Are any generic versions available?
- When and how should my child take the medicine? With food or without?
- How often will you monitor my child while they take the medicine?
- How long should it take to start working?
- What kind of improvement can we expect?
- What are the possible side effects?
- What should I do if my child has side effects or the medicine isn't working?
- For how long will my child need to stay on it?
- How should my child come off the medicine? Can they just stop taking it, or do they need to taper off slowly?
Expect to see the doctor about once every three to six months for follow-up visits. At these appointments, the doctor will check your child's height, weight, heart rate, and blood pressure. They'll ask whether ADHD symptoms have improved and if your child has had side effects from the treatment.
What to Do When the Medicine Isn't Working
When the medicine is working, you should see improvements like these in your child:
- Better ability to focus for long periods of time
- Improved mood
- Less impulsive behaviors
- Calmer emotions
For some kids, the medicine works, but not well enough. Timing could be the issue. If your child isn't focused enough in the morning, they can wake up an hour earlier than usual, take the medicine, and then go back to sleep. Or they might try a new form of methylphenidate that's made to be taken in the evening. It helps kids stay focused in the early morning when they're getting ready for school.
If your child starts to lose focus before the school day is over, a longer-acting medicine might help. Or you can keep a separate bottle of medicine at school and have them take a midday dose.
If the medicine your child is on isn't working or it causes side effects, the doctor may:
- Increase or decrease the dose
- Change to an extended-release form of the drug
- Change the dosing schedule
- Add another medicine
- Try a different stimulant or a non-stimulant
It's also possible that the diagnosis was wrong and your child doesn't actually have ADHD, or they have another condition with it. Learning disabilities, anxiety, and other mood disorders are just some of the conditions that can look like or happen along with ADHD. These disorders have different treatments.
How Long Do Children Need to Stay on Medication?
ADHD isn't like a cold or the flu. It's a long-term condition. Some people continue to have problems with focus, attention, and other executive functions into adulthood. Your child can stay on an ADHD medicine as long as needed to manage their symptoms.
Some parents wonder if their child can take a break from medicine on weekends or over the summer, which doctors call a "drug holiday." The benefit is a break from side effects. The risk is that ADHD behaviors could return.
Experts say kids with inattention may be fine without their medicine outside of school, but those with hyperactivity could have more behavior issues if they stop. Your child's doctor can advise you on the best summertime medicine approach.
Show Sources
Photo Credit: Olga Shumytskaya/Getty Images
SOURCES:
ADDitude: "ADHD Medications Rarely Work Perfectly on the First Try," "Considering a New ADHD Medication? Ask These 13 Questions First," "How to Manage ADHD Meds at School," "Jornay PM: A New Methylphenidate Formulation Now Available In the U.S."
American Psychiatric Association: "What is ADHD?"
Attention Deficit Disorder Association: "Understanding ADHD," "What To Do When ADHD Medications Don't Work."
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): "The Role of Medication," "What to Ask Your Child's Doctor About New ADHD Medications."
Child Mind Institute: "ADHD: The Pros and Cons of a Drug Holiday," "How Is the ADHD Brain Different?" "Questions to Ask a Doctor Prescribing Medication to Your Child."
Cleveland Clinic: "ADHD Medication."
FDA: "Highlights of Prescribing Information: Jornay PM."
Harvard Medical School: "5 Common Problems That Can Mimic ADHD."
HealthyChildren.org: "Common ADHD Medications & Treatments for Children."
Michigan Medicine: "Adderall Shortage May be Associated with Increased Use of Alternative ADHD Medication in Kids."
National Institute of Mental Health: "Attention-Deficit/Hyperactivity Disorder: What You Need to Know."
Nemours TeensHealth: "ADHD Medicines."
Pediatrics: "Clinical Practice Guidelines for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents."
UC Davis Health: "Medications Used to Treat ADHD."
