Stimulant medication treatment is among the most effective medications in the treatment of ADHD in children. In fact, it is highly effective in 75%-90% percent of children with ADHD. Stimulants provide the greatest improvement in the core symptoms of ADHD (inattention, impulsivity and hyperactivity) of any treatment method, and are shown to help a child maintain attention and exhibit greater self control. Stimulants primarily work by increasing the arousal levels in the frontal cortex of the brain. The frontal cortex has been identified as the area of the brain most responsible for attention, impulse control, and awareness of environmental cues.
Stimulant Medication Treatment
Stimulant medication treat ADHD by “stimulating” the frontal lobe of the brain. Many stimulant medications have received FDA approval for the treatment of ADHD in children. Stimulants are fast-acting and work the same day that they are administered. Many types of stimulant medications exist including:
Extended release stimulants: These medcations are usually administered once a day in the morning, and maintain effectiveness for 8-12 hours. Extended-release stimulants are currently the most commonly used forms of stimulants. Examples include:
Concerta (Methylphenidate)
Adderall XR (Mixed amphetamine salts)
Focalin XR (Dexmethylphenidate)
Metadate CD (Methylphenidate)
Ritalin LA (Methylphenidate)
Vyvanse (Lisdexamfetamine Dimesylate)
Daytrana (Methylphenidate trans-dermal patch)
Moderate release stimulants: These medicines are often effective over the school day, but usually do not provide treatment in the afterschool hours as they work for 6-8 hours. Examples include:
Ritalin SR (Methylphenidate)
Dexedrine Spansule (Dextroamphetamine)
Metadate ER (Methylphenidate)
Short acting stimulants: These medications are typically strongest 1-2 hours after administration, and are no longer effective after 3-4 hours. They often need to be administered multiple times per day. Examples include:
Adderall (Mixed amphetamine salts)
Methylin (Methylphenidate)
Focalin (Dexmethylphenidate)
Ritalin (Methylphenidate)
Stimulant Medication Treatment Efficacy
Decades of research have confirmed the short-term effectiveness of psychostimulant medications in improving the most troublesome symptoms of ADHD, short attention span and poor impulse control. Benefits of psychostimulants include:
Improved attention and concentration: Research has consistently demonstrated that stimulant medications are the most effective treatment of the core symptoms of ADHD
Improved behavior at school: Stimulant medications have been shown to contribute to a significant reduction in negative behaviors in the classroom, as well as improve sustained attention, persistence of effort, impulse control, reacting time, and rule following behaviors.
Improved behavior at home: Stimulants have been shown to reduce disruptive behaviors and increase compliance with parental instructions in the home setting.
Decreased aggression: Moderate dosages of stimulant medications have been shown to lead to significant reductions in aggressive behaviors in children with ADHD.
Decreased emotional overreactivity: When given to children with ADHD, moderate dosages of stimulant medications have been shown to reduce emotional overreactivity, both in terms of intensity of emotional reactions and the speed with which the child’s emotional state changes.
Improved social interactions: Improvements in all of the areas discussed above have been shown to have a positive impact on the social interactions of individuals with ADHD, especially in group settings.
Improved self-esteem: Children with ADHD who are effectively treated with stimulant medication have more success in academic, behavioral, and social functioning, which commonly leads to improved self-esteem in a wide variety of domains.
Much of the information on efficacy and effectiveness of stimulant medications come from the Multimodal Treatment Study of Children with ADHD (MTA). The MTA study is the most comprehensive study to date of the efficacy of various treatment approaches for children with ADHD. Children received carefully managed medication, behavioral, or combined treatment for a period of 14 months. Other important findings from this study includes:
Improvement was maintained over the 14-month period of the study. Additionally, initial data suggests that gains were maintained at the 24 month time point (10 months after the study ended).
Children receiving either stimulant medication alone or stimulant medication combined with behavioral management demonstrated more improvement in inattention, hyperactivity, and impulsivity than children who did not receive carefully managed stimulant medication.
Stimulant Side Effects
As with any medication, stimulant treatment is associated with a number of side effects and difficulties that is important to be aware of. Most commonly demonstrated side effects of stimulant medication treatment are:
Decreased appetite
Sleep problems
Weight loss
headaches and stomachaches
Increased anxiety and irritability
Very rare side effects of stimulant medication include the development of tics, increased aggressiveness, severe emotional distress, or psychosis. If any of these occur, a child should be discontinued from stimulant medication treatment immediately.
Some children with ADHD may experience a loss of energy and/or social withdrawal while taking stimulant medication (often referred to as being in a "zombie-like" state). This is not a common side effect of effective medication treatment, but is instead usually an indication that a child is either on too high of a dose or is poorly tolerating the medication.
The FDA has indicated a number of other risks or side effects of stimulant medications. Stimulant medications carry an elevated risk of possible cardiovascular side effects. Although extremely rare, some individuals taking stimulant medications have been observed to have a slightly higher risk of heart attack, stroke, or other cardiovascular problems. Additionally, stimulants carry a mild risk of psychiatric difficulties, such as psychosis. However, this risk is extremely mild, as only 1 in 1,000 individuals taking stimulant medication were observed to have significant psychiatric difficulties.
Parents may also report what is known as a "rebound effect." A rebound effect occurs when the child experiences an increase in ADHD symptoms or irritability as their medication is wearing off. True rebound effects are somewhat rare, although parents may notice a contrast between the child's behavior on and off the medication.
About 20-25% of children will not show a significant improvement as a result of stimulant treatment. In some cases, adjusting the dose or trying a different stimulant medication will produce an effective response. In other cases, a child may respond to a non-stimulant medication, such as Atomoxotine (Strattera). However, some children with ADHD simply do not respond to any of the available forms of medication treatment.
Non-Stimulant Medication Treatment
Although stimulant mediction are the most effective treatment for children with ADHD, non-stimulant medication options do exist. Initial evidence suggests that Intuniv and Strattera show some effectiveness at reducing ADHD symptoms, but may not be as effective as stimulant medication Many times it may be used in cases where the child has not responded to stimulant medications or where supplemental medication treatment is required. Current non-stimulant medications include:
Guanfacine (Intuniv)
Atomoxentine (Strattera)
Non-Stimulant Side Effects
Non-stimulant medications such as atomoxetine (Strattera) also carry side effects. The primary side effects noted from Strattera include:
Loss of appetite
Nausea
Excessive sleepiness
Increased anxiety
Additionally, the FDA has indicated that Atomoxetine (Strattera) carries a mild risk of increased suicidal thoughts when taken by children and teenagers. This warning does not apply to stimulant medications.
ADHD Medication Myths
Myth: ADHD medications have dangerous side effects. Fact: ADHD medications are among the most heavily researched of all psychiatric medications. Research has shown that most children only experience a few minor side effects, such as decreased appetite or difficulty falling asleep. While all medications carry some risk, very few children experience serious side effects from medications used to treat ADHD.
Myth: The medication will make my child act like a “zombie.” Fact: Most children with ADHD are still energetic and full of life while taking medication. They are just better able to control and channel their energy. If your child does exhibit a loss of energy or appears withdrawn this may mean that the dose of medication is too high, or there is a co-occurring condition such as depression. In these instances, talk to your child’s pediatrician about an adjustment of the medication dose to help lessen the side effects, or a possible screening for another illness like depression.
Myth: If I put my child on medication there is no reason to try psychosocial treatment (counseling) Fact: Studies report that medications are most effective when combined with psychosocial treatment/counseling. Medications reduce the core symptoms of ADHD – inattention, hyperactivity, and impulsivity – but will not necessarily eliminate all problems with behavior, organization, mood, peer relationships, etc. An analogy that may be helpful is to consider treatment of reading difficulties in a child with poor eyesight. In this analogy medication may be thought of as similar to putting glasses on a child – it will allow them to better see the words but will not teach them to read. Psychosocial treatment/counseling can help you and your child learn to use their improved attention and impulse control to build better social skills, coping skills, and academic strategies to improve their mood, behavior, and academic performance.
Myth: Using medication will make my child more likely to abuse drugs or alcohol in adolescence. Fact: Studies have shown that children with ADHD who are on effective medication treatments are actually less likely to abuse drugs or alcohol in adolescence and adulthood. Instead, people with untreated ADHD are more likely to engage in risky behaviors such as drug or alcohol use. Children cannot get “high” off their ADHD medication if it is taken properly, and they do not get “addicted” to the medication either.
Myth: Medication is an excuse for laziness and will make my child less motivated to work hard Fact: An ADHD medication can allow your child to see the rewards of his/her hard work. A medication can help your child do well in school, exhibit good behavior, and have successful relationships with peers. Studies show, too, that children who benefit from ADHD medications see their success as a result from their effort and hard work rather than from the medication. Your own motivational words and actions as a parent can erase any negative impact that taking medication may have on your child
