Top 10 Questions About Meds, Part 2
6. How long do the medications last?
The short-acting forms of methylphenidate, amphetamine, and mixed amphetamine salts last about four hours. Each also comes in an eight-hour form, and methylphenidate comes in a 12-hour form. The recently introduced methylphenidate skin patch works for up to 12 hours. It’s critical that your child be "on" medication whenever hyperactivity, inattention, or impulsivity threatens to interfere with important activities. (That goes for sports and other after-school activities, as well as classroom time.)
7. What options are available for children who have trouble swallowing pills?
Methylphenidate is available in liquid and chewable forms, as well as in pill form. It's also possible to get stimulants in capsules, which can be opened and the contents sprinkled on food. Another option is the methylphenidate skin patch.
8. How will the doctor determine the correct dosage?
The correct dosage of a stimulant is determined not by the child’s weight or age, but according to how efficiently his body metabolizes the medication. Thus, a seven-year-old who tips the scale at 50 pounds might need a dosage higher than the one that works for a 200-pound adult.
Most doctors start with a very low dosage of a particular stimulant, and then raise it every week or two until the benefits level off, or side effects become a problem (feedback from parents and teachers is very important). Then the previous dosage is usually deemed to be the best one for that patient.
Some doctors alternate methylphenidate and amphetamine, to see which is preferable. "I always have my patients try both types of stimulant medication, because people tend to prefer one over the other," says Dr. Dodson.
9. I understand that stimulants don't work for some kids. Is that true?
Yes. Some children don't respond to stimulants. Others respond but are unable to tolerate the side effects. What's more, stimulants may be inappropriate for children who take inhaled steroids for asthma, or anyone who has bipolar disorder, a history of drug addiction, seizure disorder, or an eye condition known as narrow-angle glaucoma. And, of course, kids with certain heart conditions should not take stimulants.
For these children, doctors sometimes prescribe the non-stimulant medication atomoxetine (Strattera). Recent reports suggest, however, that this mediation is not especially effective for some children with ADHD. Its side effects include nausea, vomiting, and dizziness, and some reports suggest that the drug can affect the liver and heart.
Tricyclic antidepressants, such as imipramine (Tofranil) and desipramine (Norpramin), or the antidepressant bupropion (Welbutrin), can help alleviate hyperactivity and inattention, although these meds tend to be less effective against impulsivity. In this case, blood pressure drugs like clonidine (Catapres) or guanfacine (Tenex) can be helpful.
10. I've heard that some parents allow their children to go off medication at times — for example, during weekends or over the summer. Are "drug holidays" a good idea?
Some experts, including Dr. Copps, are dubious of this practice. "One-third to half of your child's education occurs outside of school," he says. "If he can't pay attention, he can't learn."
Dr. Silver says parents often tell him that their child does not need meds at home because they can "handle" these behaviors there. In response, he says, "I ask if they spend a lot of time telling their child to 'sit still,' 'stop jumping on the couch,' 'leave your sister alone,' and 'stop interrupting me when I'm on the phone.' If the answer is 'yes,' I tell them, 'You may be living with these behaviors, but you're not tolerating them. Think about what you're doing to your child's self-esteem.'"
On the other hand, children who have used a stimulant successfully for some time might be given a brief trial off the drug, to see if it is still necessary. This should be done only when school is out—and only with a doctor's supervision.
"About 50 percent of kids with ADHD need medication into adulthood, and about half just get better with time," says Dr. Wilens. "By tapering the medication off and then letting the child go without it for a couple of weeks, we can see if changes in therapy are needed."