ADHD: Should My Child Take Medicine for ADHD?

ADHD (attention deficit hyperactivity disorder) affects a child's behavior and ability to pay attention. ADHD symptoms are noticed early in a child's life and continue into adulthood.

Children with ADHD tend to be:

• Inattentive. They are easily distracted and find it hard to focus on any one task.
• Impulsive. They act before thinking about the cause and effect of their actions. They may talk or laugh too loud or get more angry than the situation calls for. They may not share or be able to wait for their turn.
• Hyperactive. They can't sit still for even a short time. They may squirm, fidget, or run around at the wrong times.

It may be hard to know if your child has ADHD or is just misbehaving. It's normal for a child to be inattentive, impulsive, or hyperactive from time to time. But if these behaviors continue or become worse, they may be signs of ADHD.

The exact cause of ADHD is not clear, but it tends to run in families.

Some medical problems have symptoms that look like ADHD, so it's important that your child gets the right diagnosis. Your doctor may do some tests and ask you and your child questions to help rule out other problems, such as depression or an anxiety disorder. Sometimes the symptoms of bipolar disorder and ADHD can be confused.

The symptoms of ADHD can also be confused with a learning disability. A psychologist can do some tests to see if your child is having trouble learning how to read, write, or do math problems.

There is no cure for ADHD. But treatment can help manage your child's symptoms.

Without treatment, your child is more likely to:

• Do poorly in school or at work.
• Be rejected by his or her peers.
• Have relationship problems with family members and friends.
• Have low self-esteem.
• Be depressed.
• Lack social skills.

Stimulant medicines are most often used to treat moderate to severe symptoms of ADHD. These medicines affect the way your child's brain controls impulses, behavior, and attention.

Stimulant medicines are sorted into two groups:

• Amphetamines, such as Adderall and Dexedrine.
• Methylphenidate, such as Concerta, Metadate CD, and Ritalin.

If these medicines don't help, your doctor may suggest nonstimulant medicines to treat ADHD. These include:

• Atomoxetine (Strattera).
• Clonidine (Kapvay).
• Guanfacine (Intuniv).

Sometimes antidepressants are also recommended.

Stimulant medicines are the most effective treatment for ADHD. They improve ADHD symptoms in about 70 out of 100 children who take them.^{footnote 1} This means that they don't improve symptoms in about 30 out of 100 children who take them.

Studies have shown that children who take stimulant medicines:^{footnote 1}

• Are calmer.
• Are more attentive, focused, and organized.
• Interrupt less often.
• Have better relationships with family members and friends.

Studies have also shown that:^{footnote 2}

• The nonstimulant medicine atomoxetine can reduce ADHD symptoms in children and adults.
• The nonstimulant medicine clonidine combined with a stimulant medicine may reduce ADHD symptoms.

Even though medicine can help improve your child's symptoms, it can't solve all of your child's behavior problems. Your child may also benefit from counseling, behavior therapy, or social skills training.

Your child will take pills every day for as long as he or she needs them. It's important that your child takes the medicine as prescribed and keeps taking it so it has time to work.

If you don't see any improvement in your child's behavior, talk to your doctor. Your child may need to try several different medicines to find one that works for him or her.

You'll need to closely watch your child after he or she begins to take the medicine. The medicine may cause side effects, but they will usually go away within the first few weeks. If they don't, your doctor may need to lower the dose.

Common side effects include:

• Loss of appetite.
• Headaches.
• Upset stomach.
• Sleep problems or drowsiness.

Stimulant medicines may be related to slower growth in children, especially in the first year of taking the medicine. But most children seem to catch up in height and weight by adulthood. Your doctor will keep track of your child's growth and watch for problems.^{footnote 2}

Studies show that when used for only a short time, medicines for ADHD are safe and can help improve your child's behavior and quality of life. But there are some risks. And the effects of using these medicines over the long term haven't been studied. You'll need to weigh the benefits of your child taking medicine with the possible risks.

FDA advisories

There is a small chance that a child may think about suicide when he or she takes atomoxetine or an antidepressant. The U.S. Food and Drug Administration (FDA) doesn't recommend that people stop using these medicines. Instead, people taking these medicines should be watched for warning signs of suicide, such as saying they're going to hurt themselves, talking or writing about death, or giving away their things. This is especially important at the beginning of treatment or when doses are changed.

Studies have found that less than 1 out of 100 children who used atomoxetine thought about suicide, while more than 99 out of 100 didn't.^{footnote 3}

Most medicines for ADHD come with an FDA warning about possible heart-related or mental health problems. Be sure to tell your doctor if your child has any heart problems, heart defects, or mental health problems or if there is a family history of these problems.

The FDA has issued an advisory about atomoxetine and the risks of liver injury, orthostatic hypotension, and syncope. Call your doctor if you have nausea or belly pain. Also, call your doctor if you feel dizzy or lightheaded or if your skin is yellowing.

If your child is age 4 to 5 years, then treatments other than medicine may be enough to help your child improve his or her behavior. Behavior therapies and extra support at home and in school can help your child succeed and feel better about himself or herself. If your child is age 6 years or older, the doctor will suggest medicine or behavior therapy or both.

These treatments work for some children:

• Behavior therapy can help your child understand why he or she acts a certain way. And it can help your child find positive ways to deal with problems by changing the way he or she thinks and behaves. Behavior therapy encourages positive behavior through praise or rewards. It discourages unwanted behavior through time-outs or loss of privileges.
• Social skills training can help your child be less aggressive and impulsive, manage anger, and behave in a more socially acceptable way. It uses specific steps and goals, such as helping your child learn how to listen and engage in conversation or be part of a new group.
• Counseling, including family therapy, allows your child and the entire family to express fears and concerns, recognize problem behaviors, and learn new ways of getting along.

Your doctor may suggest that your child take medicine if:

• Your child is 4 or 5 years old and his or her symptoms have not improved with behavior therapy.
• Your child is age 6 years or older.