Medication management has emerged as one of the primary treatment modalities for children with ADHD. Studies indicate that behavior therapy has positive effect when combined with medication for pre-adolescent children. Additionally, studies report that the combination allows for use of lower doses of stimulant medications, and possibly reduces the risk of adverse effects.
Before initiating medication, a comprehensive evaluation is crucial. This involves:
- A detailed medical history to rule out other potential causes of the symptoms.
- Discussion about the risks, benefits, and alternatives to medication.
- Baseline measurement of height, weight, blood pressure, and heart rate, given the potential effects of stimulants on appetite, growth, and cardiovascular system.
- Monitoring and Follow-up
There are primarily two categories of medications prescribed for ADHD: stimulants and non-stimulants.
These are the most commonly prescribed medications for ADHD. Contrary to what their name suggests, stimulants calm and focus children with ADHD by increasing the levels of specific neurotransmitters in the brain, particularly dopamine and norepinephrine. Examples include:
- Methylphenidate-based medications (e.g., Ritalinâ, Concertaâ, Daytranaâ, Quillivant XR)â.
- Amphetamine-based medications (e.g., Adderallâ, Vyvanseâ, Evekeoâ).
These medications can be effective for children who don’t respond well to stimulants or who have certain contraindications. They work differently than stimulants and may take longer to observe therapeutic effects. Examples include:
- Atomoxetine (Stratteraâ)
- Guanfacine (Intunivâ)
- Clonidine (Kapvayâ)
When starting a child on ADHD medication, a “start low and go slow” approach is recommended. The initial dose is typically on the lower end of the recommended dosing range, and it’s incrementally adjusted based on the child’s response and any side effects experienced. Regular follow-ups with a pediatrician or child psychiatrist are crucial during this titration phase to monitor efficacy and tolerability.
Medication efficacy should be assessed using a combination of parent and teacher feedback, direct observation, and standardized rating scales. The primary outcomes of interest include improvements in attention, impulsivity, and hyperactivity.
Possible side effects of stimulant medications include decreased appetite, sleep disturbances, weight loss, increased heart rate, and potential increases in blood pressure. Non-stimulants can have side effects like drowsiness, fatigue, and stomach upset. It’s imperative to discuss any observed or reported side effects with the prescribing clinician.
The duration for which a child should be on ADHD medication varies. Some children may only need medication during school hours or specific activities, while others may benefit from continuous coverage. The decision on medication duration should be individualized and based on the child’s symptom profile, the medication’s duration of action, and the presence of any coexisting conditions.
Some clinicians and parents consider “medication holidays,” or breaks from ADHD medications, especially during weekends or vacations. These breaks can help assess if the child still needs the medication, provide insight into its long-term effects, and potentially reduce side effects like growth suppression. However, the decision to implement medication holidays should be made on a case-by-case basis and under the guidance of a healthcare professional.
ADHD medications, especially stimulants, have potential for misuse, particularly among adolescents. It is essential to counsel families and patients about the importance of safe storage, not sharing medications, and being aware of the signs of misuse.
While medication can be a critical component of ADHD management, it’s most effective when used as part of a comprehensive treatment plan. Behavioral therapies, psychoeducation, academic support, and parent training can be crucial adjuncts to pharmacotherapy.
Medication management for children with ADHD requires a systematic and individualized approach. The decision to start, stop, or change medications should always be made collaboratively with the child, family, and healthcare provider. Regular monitoring, being vigilant about potential side effects, and integrating non-pharmacological interventions are crucial for optimizing outcomes for children with ADHD.
Contact Mercie Health and Wellness to schedule a consultation to discuss medication management for ADHD. At Mercie Health and Wellness in Katy, Texas we provide a comprehensive, patient-centric approach involving regular monitoring and find that multiple treatment modalities often yield the best outcomes. You will always be treated with respect and dignity at Mercie Health. Contact us to schedule a consultation to learn more about attention deficit hyperactivity disorder, receive the correct diagnosis and all your treatment options.
At a Glance
Dr. Sylvia Udokoro Nwakanma
- Doctor of Nursing Practice (DNP)
- Double Board Certified in Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) and Family Nurse Practitioner (FNP-C)
- SAMSHA Certified Addictions Nurse Practitioner
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