Should my child take stimulant medications for ADHD?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Trying to decide whether to give your child medicines to treat attention deficit hyperactivity disorder (ADHD) can be confusing and even agonizing. When deciding about medicines, parents need to weigh the benefits of taking stimulants—improved performance at school and home—and the risks. Consider the following when you are making your decision:
- You may want to have a psychologist test your child for learning disabilities.
- You may want to try professional counseling, behavior management, and social skills training before stimulants, especially if you think your child's symptoms are mild or related to another condition.
- If your child's performance at school and his or her relationships are affected, you may want to consider stimulant medicines because they are the most effective treatment for ADHD, resulting in a dramatic improvement in behavior and other symptoms in about 70% of people with ADHD.1
- Stimulants will help curb symptoms of ADHD—hyperactivity, impulsivity, and inattention—but they will not solve all of your child's behavior problems.
- Although short-term studies have shown stimulant medicines are safe, long-term effects have not been studied. A recent 3-year study found that children grow almost 0.5 in. (1.3 cm) a year slower than those children who are not on medicine, although it is possible that your child might catch up over a period of time.2, 3
- You may want to try the new nonstimulant medicine atomoxetine (Strattera) if stimulant medicines are not effective or have lasting side effects.
Medical Information
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder that causes inattention, hyperactivity, and impulsivity. People with ADHD have a hard time concentrating, sitting still, and controlling their impulsive thoughts or behaviors. In addition, ADHD can lead to problems with memory and organization.
Behavioral symptoms begin early in childhood and lead to problems at school, at home, and with friends. Consequently, the child may develop low self-esteem or symptoms of depression if ADHD is left untreated.
What medicines are used to treat ADHD?
The medicines most often used to treat ADHD are stimulants, such as Ritalin, Concerta, Metadate CD, Focalin, Dexedrine, Adderall, and Daytrana. These medicines affect the way the brain controls impulses, behavior, and attention span. Some medicines are short-term (last 4 hours) and others may last all day.
A nonstimulant medicine called atomoxetine (Strattera) has been approved for ADHD. This medicine may be prescribed if stimulant medicines are not effective or if they have lasting side effects. Strattera is not a controlled drug, which means phone refills are allowed. The U.S. Food and Drug Administration (FDA) has issued an advisory on Strattera. It suggests that parents and other caregivers closely watch for warning signs of suicide in children and teens taking this medicine.4 The FDA does not recommend that people stop using this medicine. Instead, people who use it need to be watched for warning signs of suicide.
Other medicines may be used to treat ADHD if stimulants have not been effective. Antidepressants (such as Wellbutrin) may be helpful. Antihypertensives (such as Catapres and Tenex) can help control aggressive and impulsive behaviors in some people.
Stimulant medications with amphetamine, such as Adderall, that are used for the treatment of ADHD are approved by the U.S. Food and Drug Administration (FDA) for children age 3 and older. Stimulant medications with methylphenidate, such as Ritalin, are approved for children age 6 and older. A doctor may prescribe Ritalin for a child under age 6 based on the child's specific needs.
What are the side effects of these medicines?
Side effects of medicines used to treat ADHD are usually mild and temporary, lasting only a few weeks. The most common side effects of stimulants are decreased appetite, difficulty falling asleep, stomachache, and headache. When the dose is lowered, these side effects usually fade quickly.
Although short-term studies have shown that stimulant medicines are safe, long-term effects have not been studied. In a recent 3-year study, children who took stimulant medicine grew almost 0.5 in. (1.3 cm) a year slower than those children not on medicine. The study followed 540 youngsters with attention deficit hyperactivity disorder (ADHD) who were ages 7 to 9 at the start of the study. More studies are needed to determine whether growth is affected at other ages (younger than age 7, older than age 9) and whether children taking these medicines might catch up over a period of time.2, 3 As with any medicine, parents should balance the benefits their child might receive from these medicines with any potential risks.
What are the risks of not treating ADHD?
When ADHD goes untreated, your child is at greater risk for poor school performance. Relationships with friends or family members may be troubled due to impulsive or aggressive behaviors. Peers often reject children with uncontrolled ADHD, which then leads to self-esteem problems for the child. It may be difficult for the child to learn appropriate social skills that help him or her be accepted by peers, teachers, and others. Some people with untreated ADHD have difficulty finishing school or keeping a job and difficulty with relationships as they become adults.
If you need more information, see the topic Attention Deficit Hyperactivity Disorder.
Your Information
Your choices are:
- Have your child take medicines alone to improve ADHD symptoms.
- Have your child take medicine along with counseling, behavior management, social skills training, or other treatments to improve symptoms.
- Do not have your child take medicine, and try to reduce impulsivity, inattention, and hyperactivity through other treatments such as behavior management, education, and social skills training.
The decision about whether to have your child take stimulant or other medicines for ADHD takes into account your personal feelings and the medical facts. It is important for parents to be honest with their child about the possible risks and benefits of the medicine.
Deciding about having your child take medicines for ADHD Reasons to take ADHD medicines Reasons not to take ADHD medicines
- Your child is not able to control impulsive or aggressive behaviors, which are causing relationship problems.
- Your child is performing poorly in school due to inability to concentrate, focus, or sit still.
- You have tried other treatments such as behavior management, but they have not helped.
- You are concerned that your child's self-esteem may be affected.
Are there other reason you might want to give your child medicines to treat ADHD?
- Symptoms are sporadic and do not interfere with daily living or relationships.
- You want to try other treatment, such as social skills training or behavior management.
- Your child is performing at or near grade level.
- You are concerned about the unknown long-term effects of taking medicine.
Are there other reasons you might not want to give your child medicines to treat ADHD?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about giving your child medicine to treat ADHD. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
My child is able to maintain friendships. Yes No Unsure My child's school performance is average or above average. Yes No Unsure My child can sit still long enough to read a book. Yes No Unsure My child has a learning disability. Yes No Unsure My child has low self-esteem or seems to be depressed. Yes No Unsure My child is age 6 or older. Yes No NA* My child has been diagnosed with ADHD. Yes No NA My child is able to make and keep friends. Yes No NA My child can follow through with most age-appropriate tasks I ask him or her to do. Yes No NA *NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicines to treat ADHD.
Check the box below that represents your overall impression about your decision.
Leaning toward giving my child medicines to treat ADHD
Leaning toward NOT giving my child medicines to treat ADHD
Return to the topic Attention Deficit Hyperactivity Disorder.
| Author: | Jeannette Curtis | Last Updated: April 17, 2008 |
| Medical Review: | Michael J. Sexton, MD - Pediatrics Mina Dulcan, MD - Child and Adolescent Psychiatry | |
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