Making the decision to give your child medications for ADHD is never easy. If you are still unsure, it is helpful to do a cost/benefit analysis if you haven’t already. Be sure to be well informed before you make a decision either way. In this article, I outline what you need to know about ADHD medications for your child. Here, I answer many of the common questions parents have about medications.
Which medication is best for my child?
Doctors can’t know for sure which medication is best for your child or how your child will respond until they are tried.
The good news is that most kids (60%) respond well to the first medication they receive. However, there are the other 40% who don’t, so it may take time to figure out what will work best for your child. Therefore, it is important to be patient and work closely with your doctor to find the right medication and optimal dosage.
Sometimes kids do well with one medication that lasts throughout the day. Others might need one long-acting dose to get through the school day plus one short-acting dose to help with homework at the end of the day. Every child is different. But, with the right medication, your child’s ability to focus, to regulate emotions, to learn, and to interact with peers may improve. These all also help to boost confidence and self-esteem.
What dose is best for my child?
Unlike other medications, the dose does not depend on your child’s weight or age. The severity of the symptoms do not matter either. The best dosage depends on three things:
- How the medication is absorbed in your child’s GI tract,
- how the medication is metabolized, and
- how the medication passes across the blood-brain barrier.
Because doctors do not know how efficiently the medications will be absorbed and metabolized, some fine-tuning needed to find the right dosage depending on how sensitive your child’s body is to a particular medication.
Does the dose have to change over time?
Yes, the dose of medications will change as your child gets older,; especially in the teen years since hormone changes can change the effectiveness of medications.
Professional guidelines recommend changing the dose every year to maximize effectiveness until adulthood. Adults likely do not need to change their dosages.
How long does it take for ADHD medication to start working?
The effects of stimulants can kick in as quickly as 30 minutes, with others taking an hour or two to get started. The effects of non-stimulants take much longer than stimulants, up to four to six weeks to show any changes.
Although symptoms might improve, overall functioning can take months to improve because things like patterns of behaviour and interactions with others take time. Because the brain is still developing, regardless of medications, certain things still may take years to develop so it is important that you maintain realistic expectations for your child.
How long does the medication last?
Talk to your doctor about your child’s specific medication, as they all differ. Further, how long the medication will last specifically for your child depends on your child and will only be known for sure by careful monitoring.
Nonetheless, generally speaking, most stimulants prescribed today are long acting, meaning that they last all day (10-16 hours) and only need to be taken once in the morning. These long-acting stimulants are prove to be the most effective in managing ADHD with less rebound and better tolerability.
There are shorter acting stimulants that last only a few hours (3-4 hours) but need to be taken more than once through the day. These are not usually prescribed nowadays, though doctors will sometimes prescribe a long acting medication to help kids get through their school day, along with a short acting medication for the afternoon to get through homework.
Non-stimulant medication stay in the system and need to be taken everyday.
How often does my child have to take the medication?
Typically kids take their medication every day. With stimulants, some kids take breaks on weekends and holiday breaks. However, breaks need to be planned, so consistency is key.
Non-stimulants need to be taken every day to say in the bloodstream and maintain its effectiveness.
Because some medications cannot be stopped or might have negative effects, it is critical to discuss any breaks you plan to take with your doctor.
How long does my child need to take the medication for?
When coupled effectively with environmental accommodations and behaviour strategies, some kids can function well on smaller doses of their medications. Some may be able to stop taking medications altogether by the time they reach adulthood, though researchers have suggested that more than half of kids diagnosed with ADHD still have difficulties into adulthood, especially with executive functioning, and continue to benefit from medications.
How will I know if medications are working for my child?
Some parents notice a difference within days of their child starting medications. Others question if there are any changes happening at all. There is no test to know whether the medications are working. Therefore, it is essential that you monitor whether the medications are working or not. Taking daily data is important to identify any changes you notice in your child’s social, emotional, behavioural, or physical functioning. Be sure to use a tracking form to help you document this information.
If you are not sure what to watch for, think about the major difficulties your child has and watch to see if there are any improvements in those areas. Other areas you may see benefits in include:
- Sustained attention. Kids can usually maintain their attention for longer periods of time to get things done.
- Improved behaviour. Medications can help reduce impulsivity, such as less interruptions when you are on the phone and longer time spent sitting down for dinner. Kids might share that their brains are quitter too.
- Better mood. Kids tend to feel happier and confident when the medications are working. Anxiety often improves as well because kids are experiencing more successes with learning and friends. Kids often also have less extreme emotional reactions to things.
It is important to remember that medications do not completely get rid of every symptom your child experiences. But, they do help reduce the frequency and severity of many of the symptoms, which is why tracking data is so important.
Also, be sure to work closely with your doctor. Ask your doctor how the efficacy of the medications will be monitored and measured. Regular follow-up appointments with your doctor are important to monitor progress. Ask your doctor what the follow-up schedule should look like.
At the beginning you will likely have frequent visits, such as every two weeks, until you find the right medication. From there it may spread out to every few months. Your doctor will likely have you and a teacher complete rating forms before each visit, but it will be helpful to track your child’s progress regularly between visits and bring that information to the doctor’s visit. You know your child best, so your doctor relies on you to provide valuable information about your child’s functioning to help make informed decisions about what is best.
What can I do to help reduce side effects?
Side effects may be different depending on the type of medication your child takes. And there is no one-size-fits-all; everyone reacts differently to the medications.
Side effects typically occur when the medication is still in your child’s system. Most side effects wear off after a few days of starting medications and can be fixed with adjusting the dosage or time they are taken.
Be sure to ask your kids how they feeling and to tell you if they feel “off” in any way. If you notice any concerning side effects or changes in your child’s mood (e.g., irritability or anxiety) or behaviour (e.g., aggression), be sure to take note of these and make an appointment to discuss these with your doctor.
Seek immediate medical help if your child experiences dizziness, fainting, short or trouble breathing, chest pains, pounding heartbeat, swelling, hives, or any other symptom that causes you alarm.
Here are a few ideas of things you can do if your child does experience side effects:
Sleep: Difficulties with falling asleep will get better once your child is used to the medications.
- Experiment by having your child try a nap – if your child falls asleep, that is a good sign it is the ADHD affecting sleep and not the medication. If this is the case and your child continues to have trouble falling asleep, the first thing to try is changing the timing of medications, such as earlier or later in the day. Sometimes a second dose of medication, such as a short-acting stimulant later in the day can help.
- You can also do things to help your child settle into sleep in the meantime, such as:
- Establish a consistent bedtime routine.
- Lower lights and minimize electronics and stimulating activities within two hours of bedtime is ideal. Have your child engage in quiet activities, such as reading or listening to soft music.
- Create bedtime rituals, such as having a warm bath or reading bedtime stories.
- Keep the house cool at night – this helps kids stay asleep.
- Have kids write (or you can scribe) any worries or ideas they have on their mind. This may help relax their brains from the swarm of thoughts they may have before bed.
Appetites should normalize after a few weeks (and be just fine at the end of the day). It is best to make sure kids have a good, protein-rich breakfast before taking their medication. Try to pack healthy foods for lunch and snack and encourage kids to eat when they feel hungry. Kids tend to become hungry later in the day, so have healthy snacks available and maximize caloric intake when they are hungry.
Nausea and headaches: Although rare, kids sometimes experience physical symptoms when they first start medications. Have them take the medication with food to minimize their effects.
What if the side effects outweigh the benefits?
Sometimes parents worry that the side effects of medications are worse than the benefits kids get from medications. There might be a few reasons why this happens.
The first is perhaps the medication is the wrong one for your child. Everyone is different, so perhaps a different medication will work better. Sometimes the medication is the right one but the dose is off, either too low or too high.
If the medication and dose are right, then sometimes it’s a matter of timing; kids take their medications either too early or late in the day. Sometimes the child needs to take the medications early in the day but it wears off too early; in that case perhaps a short-acting medication for the afternoon will help. Keep track of when your child takes the medication and see what is the best time to have the maximum benefits.
Be sure to talk to your doctor about any difficulties your child is having and explore these options to optimize your child’s treatment.
If you are interested in knowing what medications are available, check out CADDRA’s medication chart.
For additional resources, to check out some of these resources I personally curated:
Attidude’s Ultimate Guide to ADHD Medications
Child Mind Institute’s Understanding ADHD Medications
Caddra’s ADHD Medication Updates