When and How Should We Adjust Treatment?

Q: “My Child’s ADHD Medication Wears Off Too Early.”

Is your child’s ADHD medication wearing off too soon in the day? Talk to your doctor about prescribing an additional dose of short-acting medication for your child to take just before the effects of the initial dose fade.

Photo by Karolina Grabowska: https://www.pexels.com/photo/child-in-beige-hoodie-leaning-forward-on-table-feeling-exhausted-while-studying-6958532/

Q: “My son recently started taking ADHD medication. Though his performance and behavior at school have improved dramatically since starting on medication, the effects wear off by the time he gets home. What can we do about this? The medication lasts during the school day, which is great, but we need him to be able to focus on homework and other activities.”

This is a very common problem. ADHD medication only treats symptoms while the medication is at an effective level in the brain. Once the medication wears off, the benefits stop. That means that paying attention to how long a medication lasts, even if it is branded as long-lasting, is important.

If your child is on short-acting four-hour Ritalin, for example, a dose around lunchtime will wear off around 3:30 p.m. Not only that, but side effects like irritability might occur when the medication wears off too quickly. On the other hand, even if your child takes a 10-hour medication at 7 a.m., it will wear off at 5 p.m. — not good if your child does homework after dinner.

[Read: How to Survive the After-School Witching Hour]

Older children and teens may need medication that lasts even longer, often well into the evening hours. Otherwise, they’ll be attempting homework, tutoring, dance practice, soccer, and other activities without the benefit of ADHD medication.

As common as this issue is, there is almost always a solution that maximizes the benefits of the medication without introducing or worsening side effects. Clinicians typically solve the problem of medication wearing away too early by prescribing a short-acting medication to be taken in the evening, or whenever initial medication is wearing off. You might consider giving the short-acting medication to your child right after dinner so that it lasts for about four hours and wears off before bedtime. A low dose will also ensure that no sleep difficulties come from the added medication.

If you take this approach, you must use the same type of stimulant medication at all times. That is, if your child takes a methylphenidate in the morning, use a methylphenidate (not an amphetamine) in the evening. Download a complete chart of ADHD medications here.

How to Treat ADHD in Children: Next Questions

  1. What ADHD medications are used to treat children?
  2. Is ADHD medication right for my child?
  3. What are common side effects associated with ADHD medication?
  4. What natural treatments help kids with ADHD?
  5. What if the medication stops working?
  6. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

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