How effective is medication at controlling symptoms of ADHD in children and adolescents? Very effective. Four out of five youngsters who take medication for ADHD enjoy significant reductions in hyperactivity, inattention, and/or impulsivity. But it's essential to pick the right medication and to use it properly.
Over more than 30 years of treating youngsters with ADHD, I've developed seven rules to maximize the benefits of medication:
1. Make sure the diagnosis is correct
Not all kids who are hyperactive, inattentive, or impulsive have ADHD. These behaviors can also be caused by anxiety or depression, as well as by learning disabilities. A teacher might say that your child has trouble sitting still. A psychological test might show that your child has exhibited behaviors suggestive of ADHD. But such reports are not enough. To confirm the diagnosis, the characteristic behaviors must be shown to be chronic (to have existed before age six) and pervasive (to have been observed in at least two life settings—at school, at home, with peers, and so on.)
2. Don't expect to find the right drug right away
Some kids respond well to methylphenidate (Ritalin) or dextro-amphetamine/levo-amphetamine (Adderall). Others fare better on a non-stimulant medication, such as a tricyclic antidepressant or atomoxetine (Strattera). The only way to tell whether a particular medication works for your child is by trial and error.
3. Pick the right dose
With stimulant medications, the dose is based not on age or body weight but on the rate at which the body absorbs the medication. The only way to find the correct dose for your youngster is by trial and error. I might start with 5 mg. If that doesn't work within three to five days, I move up to 10 mg, then 15 mg, and, if necessary, 20 mg, until the child improves. If a youngster becomes unusually irritable or tearful—or seems to be in a cloud—the dose should be reduced.
4. Don't be too trusting of a medication's listed duration
Just because a pill is supposed to control ADHD symptoms for a certain length of time doesn't mean that it will. A four-hour pill might work for only three hours. An eight-hour capsule might last for six or 10 hours, a 12-hour capsule, 10 to 14 hours. Observe your child's behavior to determine how long each dose lasts.
5. Be sure your child is on medication whenever it is needed
Some children and adolescents need medication all day, every day. Others need coverage only for certain activities. Odds are, your youngster needs to be on medication during the school day. How about homework time? What about during extracurricular activities? Once you determine when your child needs to be "covered," the physician can work out a suitable medication regimen.
6. Alert the doctor about any side effects
Stimulants can cause sleep problems, loss of appetite, headache, and stomachache. A very uncommon side effect is motor tics. If your child develops side effects, the doctor should work with you to minimize them. If side effects cannot be controlled, another medication is needed.
7. Don't be too quick to suspend medication use
Some parents are quick to take their children off medication during vacations and school holidays, but this might result in frustration, social problems, and failure. Think through each activity and the demands it places on your child before deciding if it makes sense to let your child be off medication.