The most commonly prescribed drugs are Ritalin, Conceta, Dexedrine, and Adderall. In most instances, these substances have a remarkably positive effect - at least for the short term.
Yet parents are still rightly concerned about the overprescribing of these drugs. One parent wrote to Dr. James Dobson asking, "Do you worry about Ritalin and other drugs being overprescribed? Should I be reluctant to give them to my 10-year-old?" I thought his reply was timely and wise: "Prescription drugs have been used as a cure-all for various forms of misbehavior. That is unfortunate. We should never medicate kids just because their parents have failed to discipline them properly or because someone prefers to have them sedated. Every medication has undesirable side effects and should be administered only after careful evaluation and study. I couldn't agree more.
What Is The Best Stimulant Option?
As I mentioned above, the treatment for ADHD should be individualized and tailored for each child and each family.
So, while there is no "best" treatment, there are a number of excellent treatment options. Learning more about them can assist you in working with your child's physician to choose among these options.
One of the disturbing problems with using stimulant medications for ADHD has been the fact that the older medications didn't last very long. Their positive effects were not very long-lived - a few hours at most. This meant that extra doses would have to be given at school or later in the afternoon once the child was home. Medication For Adhd In Adults
Worse yet, when the short-acting medications wore off, a "rebound effect" could occur where the child's symptoms and behaviors actually worsened! This not only created difficulty for the school, it also caused embarrassment for the child and led to noncompliance.
Other side effects with the stimulant medications include anxiety, nervousness, palpitations (rapid heart beat), sweating, dry mouth, decreased appetite, and insomnia (difficulty going to sleep). More rare side effects include irritability, mood swings, depression, withdrawal, hallucinations, decreased appetite, and "loss of spontaneity." The friends of one of my young patients told her, "Carla, please don't take your medication before you come to our party. You'll be no fun!"
But I have good news. Newer medications are now available to solve this problem for many patients.
I teach my patients that the stimulants that are used to treat ADHD can be thought of as short-, intermediate-, and long-acting, The short-acting tablets of methylphenidate (available in a generic form as well as in the brand names Ritalin and Methylin) and dextroamphetamine (available in generic form as well as in the brand names Dextrostat and Dexedrine) have a quick onset of action, but they only last in the system for three to six hours - which is not long enough to get through the average school day.
Intermediate-acting medications such as Ritalin SR, Metadate ER, and Methylin ER have a much slower release into the system so their effects last longer - about six to eight hours. The regular form of a newer medication, called Adderall, also appears to last six to eight hours. This medication combines four kinds of stimulant medications. However, more than 50 percent of children require an additional dose later in the day. Another medication in this group is Focalin (dexmethylphenidate, a new formulation of the most active portion of methylphenidate).
Recently, scientists have developed controlled-release systems that give the same effect as multiple daily doses of the short- or intermediate-release medications. These newer medications are called long-acting or once-daily preparations. They are specifically designed to help your child get through the entire day on a single dose.
Adderall XR uses intermediate- and delayed-release drug-containing beads to accomplish this. A 20mg capsule of Adderall XR works the same as taking a 10mg Adderall twice a day, And if your child cannot swallow a capsule, the contents can be sprinkled on a soft food such as applesauce. Medication For Adhd In Adults
Concerta (methylphenidate) works by using a specially patented system called the OROS delivery system. Some clinicians believe that Concerta has the longest duration of action, although this has not been formally studied yet.
Metadate CD acts through the use of intermediate- and extended-release beads. Some experts believe that the effects of Metadate CD are of shorter duration than Concerta. This may be an advantage for those on Concerta who have no appetite at suppertime or have trouble going to sleep from the prolonged effects of Concerta.
Dexedrine Spansules also contain beads and last 6-10 hours. Most of these products come in several varying dosages, so they can be started at the lowest possible dose and then slowly increased.
These products release some of the drug immediately, so the effect is like giving a short-acting product. Then, they gradually release the drug over a period of hours so the effect is sustained throughout the day. For most children, this means no additional doses! However, the use of any of these drugs for ADHD is not inexpensive. Depending upon the medication and the prescribed dose, they can cost from $30 (for generic forms) to nearly $100 per month.
For a few children, symptoms may re-emerge in the late afternoon or early evening. For these kids, an intermediate-acting or short-acting preparation could be given in the early afternoon, right after school. However, this type of dosing does increase the chances that the child will have trouble going to sleep (insomnia).
One of the newest long-acting stimulants for ADHD is Ritalin LA. Each bead-filled Ritalin LA capsule contains half the dose as immediate-release beads and half as delayed, release beads, thus providing an immediate release of methylphenidate and a second delayed release.
Some of these newer, long-acting products have not yet been compared to one another in head-to-head trials. So it may be worth trying an alternate product if one doesn't work. Also, they contain different drugs (methylphenidate, amphetamine salts, or dextroamphetamine). A particular child may respond to one but not to another.
Finally, there's one drug I cannot recommend. Pemoline (Cylert) has been used for decades for ADHD. However, the Araerican Academy of Pediatrics and many other experts do not recommend Cylert for ADHD therapy, as it has been associated with fatal liver toxicity. The medicine is so potentially dangerous that many experts refuse to use it.
Want to know more about ADHD medications? You can get Medication For Adhd In Adults right away!
