ADHD Medications

The FDA has approved Strattera (atomoxetine), a nonstimulant, and the first new drug in three decades for treatment of symptoms of attention deficit hyperactivity disorder, or ADHD.

Deciding which medicine to use to treat your child with Attention Deficit Hyperactivity Disorder used to be easy. The big choice was whether to use generic or brand name Ritalin.

There are now a much larger choice among stimulants that can be used to treat ADHD. Many of the newer medications have the advantage that they only need to be given once a day and can last for up to 12 hours. Although there has been a sustained release version of Ritalin, called Ritalin SR, available in the past, most people found that it worked inconsistently.
In addition to not having to take a lunch time dose, the sustained release forms of these medications have the benefit that the medication is often still working after school, as your child is trying to do his homework.

Fortunately, according to the American Academy of Pediatrics, 'at least 80% of children will respond to one of the stimulants,' so if 1 or 2 medications don't work or have unwanted side effects, then a third might be tried. But how do you decide which medicine is best to try first? In general, there is no one 'best' medicine and the AAP states that 'each stimulant improved core symptoms equally.'

It can help if you are aware of the different medications that are available. Stimulants, are considered to be first line treatments, and antidepressants, are second line treatments and might be considered if 2 or 3 stimulant medications don't work for your child.

Stimulants include different formulations of methylphenidate and amphetamine available in short, intermediate and long acting forms.

The decision on which medicine to start is a little easier to make if your child can't swallow pills. While there are no liquid preparations of any of the stimulants, the short acting ones, such as Ritalin and Adderall can usually be crushed or chewed if necessary. The sustained release pills must be swallowed whole (except for Adderall XR).

In general, whichever medication is started, you begin at a low dose and work your way up. Unlike most other medications, stimulants are not 'weight dependent,' so a 6 year old and 12 year old might be one the same dosage, or the younger child might need a higher dosage. Because there are no standard dosages based on a child's weight, stimulants are usually started at a low dosage and gradually increased to find a child's best dose, which 'is the one that leads to optimal effects with minimal side effects.'