ADHD Medications for Children
If you’re considering an ADHD medication for your child, you need to know how stimulants — methylphenidate or amphetamine — and nonstimulants work, whether risks exist, and what dosages and frequencies are normal. Here, experts answer these and other frequently asked questions about treating your kid’s ADD.
1. What are the most popular ADHD medications for children?
- Adderall XR (amphetamine)
- Concerta (methylphenidate)
- Evekeo (amphetamine)
- Focalin XR (methylphenidate)
- Intuniv (guanfacine)
- Quillivant XR (methylphenidate)
- Ritalin (methylphenidate)
- Strattera (atomoxetine hydrochloride)
- Vyvanse (lisdexamfetamine dimesylate)
(Source: the 2017 ADDitude Treatment Survey)
2. What are the best ADHD meds for kids?
Most children with ADHD experience symptom improvement while taking a stimulant medication such as methylphenidate (Ritalin, Metadate, Concerta, Quillivant XR, Jornay PM, etc.) or amphetamine (Adderall, Vyvanse, Dynavel XR, Adzenys XR, etc.). If one ADHD medication doesn’t seem to work — or if it works only at an extremely high dosage—the doctor may prescribe another drug. (See this handy ADHD medication list for available treatments.)
There is no evidence that any particular medication is best. “Treatment of ADHD should begin with an oral stimulant, either an amphetamine or a methylphenidate-based formulation,” reports Treatment Guidelines, a highly respected newsletter for physicians about prescription drugs. “None of these drugs is inherently more effective than another… The choice of a specific drug should be based on its rapidity of onset, duration of action, and effectiveness in a given patient.”
3. ADHD medications for children — are they necessary? Is my child too young for ADHD medication?
Children as young as 4 can be diagnosed with ADHD, according to the American Academy of Pediatrics (AAP). The AAP recommends behavior parent training as the first-line treatment for preschool-aged children (children younger than 6) with ADHD. Clinicians, the AAP adds, may consider prescribing methylphenidate to a preschool-aged child with ADHD if symptoms do not improve under behavior therapy “and there is moderate-to-severe continued disturbance in the 4- through 5-year-old child’s functioning.” For children 6 and older, the AAP recommends ADHD medication along with behavior parent training.
“It is not uncommon to diagnose a child with ADHD at 5 [years of age]” said Walt Karniski, M.D., a developmental pediatrician, in the ADDitude webinar titled, “ADHD Medication Options and Benefits for Children.” “And occasionally, we will even go down to 4 or 3 years of age to make the diagnosis.”
Karniski and other experts agree that parents should consider ADHD medications when symptoms interfere with their child’s social, emotional, or academic life.
“If your child has been diagnosed with ADHD and is struggling, he probably needs medication,” says Stephen Copps, M.D., an ADHD specialist in Macon, Georgia. “Medication is the cornerstone of therapy. It’s appropriate for most children with diagnosable ADHD. It is not a last resort.”
Delaying medication, according to Karniski, could result in unintended long-term consequences.
“The longer a child goes with ADHD who’s not being treated, the greater the impact on his or her self-esteem is — and the impact is generally negative,” Karniski said.
Of course, it’s essential that your child’s diagnosis of ADHD is a reliable one. ADHD-like symptoms can be caused by a range of disorders, including anxiety, mood disorders, oppositional defiant disorder, and obsessive-compulsive disorder. In some cases, a child’s symptoms arise from the frustration associated with having to struggle with a learning disorder.
Make sure the doctor uses the diagnostic criteria spelled out in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM. The doctor should get input from your child’s teacher as well as from you, his parents.
4. ADHD medications for children — are they safe?
The stimulants commonly prescribed for ADHD are considered among the safest of all psychiatric medications. “The risks of using these medications are very low,” says William W. Dodson, M.D., a Denver-based psychiatrist who specializes in ADHD. “The risks involved in not treating ADHD are very high. These include academic failure, social problems, car accidents, and drug abuse.”
As with many prescription drugs, of course, stimulants like Vyvanse, Adderall XR, or Evekeo can interact dangerously with certain other medications. Be sure to alert the doctor about any other medications your child takes.
While some clinicians have had concerns about the impact of stimulants on cardiovascular health have, recent research published in JAMA Network Open1 has revealed the concern is unsubstantiated. The systematic review and meta-analysis based on 19 observational studies with more than 3.9 million participants, found that ADHD medications did not increase the risk of cardiovascular events among children and teens, or adults of any age.
“Although the analysis in JAMA is tremendously reassuring, it must be emphasized that the findings are based on huge populations and may not fully apply to everyone,” Dodson says. “Consequently, every case must be evaluated on its own set of facts and testing.”
Your child’s doctor should check for heart palpitations, irregular heartbeat, and fainting spells, as well as a family history of sudden cardiac death or irregular heartbeat, when giving your child a physical exam. If any of these factors are present, the patient — whether child or adult — should be evaluated by a cardiologist before taking a stimulant.
5. What are the side effects associated with ADHD medications for children?
Stimulants can cause a range of side effects, notably appetite suppression and weight loss. But these effects tend to be transient, recent studies suggest. “Eighty percent of children who take stimulants experience some appetite suppression, but this side effect usually goes away on its own within six months,” Copps says. Giving children a big meal after their medication has worn off may be enough to compensate.
ADHD medication side effects can also include headaches or difficulty falling asleep. Lowering the dosage or switching to another drug may ease these problems.
In rare cases, children taking a stimulant experience visual or tactile illusions, or develop a tic, such as blinking uncontrollably.
“No one should have to tolerate side effects,” says Larry Silver, M.D., clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. “After all, the problem can usually be solved with a simple adjustment to the medication’s dosage or schedule.”
6. Will ADHD medication stunt my child’s growth?
There has been some concern that stimulants may cause a slowing of growth in children and adolescents, however research findings are mixed. Some studies show no impact on growth at all,2 while others find what is considered “negligible” slowing of growth.3
Each time a child goes in for a checkup and a new prescription, the doctor should check his height and weight. If you find evidence of suppressed growth in your child, talk to your doctor about what steps might help.
7. How long do ADHD 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 methylphenidate skin patch works for up to 12 hours. However, these durations are based on information the drug’s manufacturers provided and may last longer or shorter than indicated. 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.)
8. 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.
9. How will the doctor determine the correct dosage of ADHD medications for children?
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,” Dodson says.
10. I understand that ADHD 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 BPD, certain heart conditions, a history of drug abuse, seizure disorder, or an eye condition.
For these children, doctors sometimes prescribe non-stimulant medications. Atomoxetine (Strattera) is the most commonly prescribed non-stimulant medication. Strattera’s response rate is approximately 50%,4 which is to say, the medication works for roughly half of the people who try it. This response rate is significantly lower than that of stimulants. Its side effects include nausea, vomiting, and dizziness, and some reports suggest that the drug can affect the liver and heart. The newest non-stimulant to be approved by the FDA is Qelbree (viloxazine hydrochloride), which was previously marketed as an antidepressant in Europe. The most common side effects of Qelbree include drowsiness, decreased appetite, fatigue, nausea, vomiting, trouble sleeping, and irritability. The antidepressant bupropion (Welbutrin), which is not FDA-approved for the treatment of ADHD but which is sometimes prescribed off-label, may help alleviate hyperactivity and inattention.
For management of impulsivity, emotional dysregulation, and irritability, alpha-agonists such as clonidine (Kapvay) or guanfacine (Intuniv) can be helpful. These medications, which are non-stimulants, can be used as a monotherapy, or in conjunction with stimulants.
11. 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 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.”
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.
That said, a recent study published in The American Journal of Psychiatry5 found that 90% of people with ADHD will continue to have symptoms into adulthood, disproving the widely-held belief that many people outgrow ADHD. While symptoms fluctuated, waxing and waning over time, only 9% of participants no longer showed symptoms of ADHD by the study’s endpoint, when most participants were 25 years old.
How to Treat ADHD in Children: Next Questions
- What ADHD medications are used to treat children?
- Are ADHD meds safe for my child?
- What are common side effects associated with ADHD medication?
- What natural treatments help kids with ADHD?
- How can I find an ADHD specialist near me?
Helpful Books for Treating Kids with ADHD
Straight Talk about Psychiatric Medications for Kids, by Timothy E. Wilens, M.D.
The ADHD Book, by Beth Ann Hill, with James Van Haren, M.D.
The Mislabeled Child, by Brock Eide, M.D., and Fernette Eide, M.D.
View Article Sources
1 JAMA Network Open, (2022), “Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis.” . doi:10.1001/jamanetworkopen.2022.43597
2Pediatrics (2014.) “ADHD, Stimulant Treatment, and Growth: A Longitudinal Study.” https://publications.aap.org/pediatrics/article-abstract/134/4/e935/77034/ADHD-Stimulant-Treatment-and-Growth-A-Longitudinal.” https://publications.aap.org/pediatrics/article-abstract/134/4/e935/77034/ADHD-Stimulant-Treatment-and-Growth-A-Longitudinal
3Journal of the American Academy of Child & Adolescent Psychiatry. (2019.) “Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder.” https://www.jaacap.org/article/S0890-8567(19)31443-1/fulltext
4Childress A. A critical appraisal of atomoxetine in the management of ADHD. Ther Clin Risk Manag. 2016;12:27-39
5Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032