ADHD medications work by increasing the amounts of two key chemicals, dopamine and norepinephrine, in your child’s brain. In the right amounts, they help your child focus.
The main type of medications used to treat ADHD are called stimulants (although there are others when stimulants don’t work or are contraindicated), and there are a lot of options available. Some are short-acting, wearing off in a few hours, and some last up to 12 hours. Studies show that studies show there’s an over 80% chance that your child will respond well to stimulant medication. So if the first medication your child tries doesn’t help, or causes negative side effects, it is worth trying a different one.
Below Dr Pablo Ronzoni, Consultant Child and Adolescent Psychiatrist, gives his top tips to help you make sure they are on the right medication and to help your child learn to successfully take the medicine.
Stimulants for ADHD work very quickly, within a half hour to an hour and a half depending on the type and dose. Your prescribing clinician will talk you through their timescales as short-acting versions last four to six hours and the extended-release versions last up to 14 hours, depending on the individual.
You will need to set a medication routine according to the demands of your child’s normal day. This will normally mean taking their medication before school (and after breakfast if possible to enable them to eat well) and possibly taking a second ‘top-up’ dose in the afternoon at school.
Getting into a routine will help you and your child remember the medication and give them the best chance of success. Pill boxes with the day of the week clearly displayed can help you prepare and reminders on your phone to ensure you order your repeat prescription in time are an easy way to get into a successful routine.
“Talking to your child about what ADHD is, using age appropriate books and highlighting the benefits of medication is always the right thing to do,” explains Dr Ronzoni. “We know that children who are aware of their condition and why they need to take medication are more successful.”
"For younger kids, I recommend All Dogs Have ADHD by Katy Hoopman and Why Can’t Jimmy Sit Still? Helping Children Understand ADHD by Sandra L Tunis and Maeve Kelly. For young people, I recommend Take Control of ADHD: The Ultimate Guide for Teens With ADHD by Ruth Spodak and Kenneth Stefano and The Art of Being a Brilliant Teenager by Andy Cope."
Taking tablets can be hard for any child and you should ask your doctor for advice if your child has any confirmed or suspected physical swallowing difficulties. Dr Ronzoni says, “Trying to swallow them with water can feel distressing, especially for a child with sensory sensitivities or a sensitive gag reflex. Try placing the tablet in a small teaspoon of chocolate spread,” recommends Dr Ronzoni. “Swallowing the tablet with the chocolate spread or peanut butter will feel like a much more natural swallow and make it easier for the child. Don’t forget to explain to the child what you are going to do and why, but this can make the process both easier and more appealing.”
Some of the common side effects of stimulants include a small increase in blood pressure and heart rate, loss of appetite, which can lead to weight loss or poor weight gain, trouble sleeping, headaches, stomach aches and mood swings. Try to keep a diary of any side effects your child reports and keep talking to them and checking in with how they feel on the medication.
Most of the side effects fade after several weeks of use, but “if they persist your prescribing clinician may need to adjust your child’s dosage to relieve those side effects”, explains Dr Ronzoni. If the side effects persist, ask them about trying a different medication or changing the form of medication.
Often your child’s school will be working with them for the majority of time that they are medicated, so it’s really important that you get regular, good quality feedback about how the medication is working, if is impacting your child’s ability to learn and make progress, and if they are experiencing side effects at school. This is particularly important when introducing a new medication, but gathering this information also helps for the regular check ups your child will need to monitor their height, weight, blood pressure and school attainment.
Working closely with the school is also very important as the treatment of ADHD does not just involve medication, but also extra support within the classroom, during breaktimes and through additional interventions which the school can put in place.
Children who take stimulant medication for ADHD sometimes have “rebound” reactions when their medication wears off. Rebound is the brain’s reaction when a stimulant medication is wearing off. When the medication leaves the system too quickly, it causes ADHD symptoms to return, sometimes with a vengeance. In children, this means they may be more impulsive or hyperactive than usual or emotional, sad or withdrawn.
The good news is that the ‘rebound’ often only last for an hour or so, and sometimes fine-tuning the medication can help. Often planning a relaxing, unwinding activity which the child particularly enjoys can ease them through this time effectively.
No matter what you or your child are struggling with, we have tools to help. If you want to speak to someone confidentially, our specialist assistant psychologists are here to link you to the right support with clinicians who can unlock change.