Medicine treatment of Attention-Deficit Hyperactivity Disorder (ADHD)

Medicine treatment of Attention-Deficit Hyperactivity Disorder (ADHD)

OVERVIEW

The goal of this post is to describe medicine treatments for Attention-Deficit Hyperactivity Disorder (ADHD).

STIMULANT MEDICATION FOR ADHD

Stimulant (also called “psychostimulant”) medicine is recommended as the first-line treatment for children (>5 years) and adolescents with ADHD.1 Several research studies support this recommendation. For example, comparing patients with ADHD who received (1) behavioral therapy only, (2) medicine therapy only, (3) combined behavioral and medicine therapy, and (4) standard therapy by community physicians, the medicine-treated patients had superior outcomes.2 Additionally, in a Longitudinal study (a study that follows patients over time) medicine treatment led to better school function, including higher reading achievement, fewer days of school absence, and improved advancement through grade levels.3

WHAT TYPES OF STIMULANT MEDICINES ARE AVAILABLE?

Stimulant medicines include methylphenidate (brand name example, Ritalin), dexmethylphenidate (example, Focalin), dextroamphetamine (example, Dexedrine), combined dextroamphetamine/amphetamine (example, Adderall) and lisdexamfetamine (example, Vyvanse).

Importantly, each medicine type can have several different brand names, usually based on how long it takes for the medicine to be delivered (IR – immediate release or SR – slow release) and how it’s delivered (capsule, liquid, patch, chewable). For example, Ritalin is a well-recognized brand name for methylphenidate, but several other brand names are also used for methylphenidate:

  1. Concerta is a brand name for a longer-acting methylphenidate pill.
  2. Daytrana is a brand name for a long-acting patch that can be worn on the skin.
  3. Quillivant XR is the brand name for a long-acting liquid.
  4. And Quillichew ER is a brand name for a long-acting chewable tablet.

Several other brand names exist for the same active ingredient, methylphenidate. It can be confusing.

ARE THERE SIDE EFFECTS?

Yes. The most common side effects are loss of appetite and sleep disturbances. Additional side effects include: belly discomfort, headache, irritability, and anxiety. These side effects are usually dose dependent, meaning that they tend to be more prominent with higher doses. Depression and suicidality (thoughts, plans, or actions of suicide) are rare, but they have been reported and should be discussed with your healthcare provider. Also, stimulant medicines tend to cause an elevation of heart rate and blood pressure. These changes are rarely substantial enough to require a medicine change, but heart rate and blood pressure should be monitored regularly especially in adults.

STIMULANT MEDICINES ARE CONTROLLED SUBSTANCES

The Drug Enforcement Administration classifies the commonly prescribed stimulant medicines such as Ritalin as class-II controlled substances, which means that they have added rules about prescribing and dispensing the medicines. The controlled substance classification is based on the potential for abuse. For this reason, medicines should be monitored closely by parents and by prescribing physicians.

WHAT ALTERNATIVES ARE THERE TO STIMULANT MEDICINES?

Alternatives to stimulant medicines include behavioral therapies (described in the previous post and non-stimulant medicines which include atomoxetine (Strattera), clonidine, and guanfacine. These medicines can also be used in addition to stimulants. Your healthcare provider can discuss reasons to choose a non-stimulant medicine and their potential side effects.

References

1. Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management, Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007-1022.

2. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56:1073-1086.

3. Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. Modifiers of long-term school outcomes for children with attention-deficit/hyperactivity disorder: does treatment with stimulant medication make a difference? Results from a population-based study. J Dev Behav Pediatr. 2007;28:274-287.