Rule #2: Don’t Expect the First ADHD Medication to Work
Four out of five kids who take medication for ADHD enjoy significant reductions in hyperactivity, inattention, and/or impulsivity. But the road to success is often curved. Here, Dr. Larry Silver explains how to choose the right medication, pick the right dose, and react to side effects.
How effective is medication at controlling symptoms of ADHD in children, adolescents, and adults? Very effective. Four out of five youngsters who take medication for ADHD enjoy significant reductions in hyperactivity, inattention, and/or impulsivity. But in order to ensure you are taking ADHD medication safely, it’s essential to pick the right medication and follow proper dosage.
Over more than 30 years of treating 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 a mood disorder, 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 patients 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 ADHD medication works for you or your child is by trial and error.
3. Pick the right dose, and give it a few days.
With stimulant medications, the dose is based not on age, weight, or body mass but on the rate at which the body absorbs the medication. (In contrast, non-stimulant medications dosages are determined by weight.) The only way to find the correct dose for you or 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 patient improves. If he or she becomes unusually irritable or tearful – or seems to be in a cloud – the dose should be reduced.
Usually, it’s possible to tell almost immediately whether a stimulant medication is working. Many physicians start at the minimum dose and increase the dose every five days until the correct dose is established (or until it becomes clear that another medication should be considered). Discuss this with your doctor.
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. Keep track of how you feel – or observe your child’s behavior – to determine how long each dose lasts.
5. Be sure you or your child is on medication whenever it is needed.
Some people need medication all day, every day. Others need coverage only for certain activities. Odds are, if your child is the one with ADHD, she 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 you or your child develop 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.