At age 4, Jeremiah Ryans routinely refused to wait in line at the water
fountain at his summer day camp. Sometimes he'd get so cranky he would hit his
classmates. But an alarm bell went off when he grabbed a pair of children's
scissors and cut his teacher's hair.
Just a kid being a kid -- or extreme behavior that may need medical help?
The answer isn't clear-cut, and it's different for every family.
"He was on the verge of being expelled from day care," remembers his
mother, Mimi, of Columbia,...
If a stimulant drug doesn't work well, the doctor might recommend another type of medicine added onto it. This is called adjunctive therapy.
Treatment With ADHD Medication
The doctor will probably start your child on a small dose of ADHD medicine. The dose will be raised slowly until your child sees an effect from it. This is called titration. The goal is to improve ADHD symptoms while causing the fewest side effects.
Because every child with ADHD is different, there isn't a one-size-fits-all treatment. Therapies are specifically designed for each child. A child might take a single medication or get a combination of medicines. Some treatments combine medicines with behavioral therapies.
But not every child who takes stimulants responds to these drugs. About 20% of kids who take stimulants don't have much symptom relief, or they get side effects.
Adjunctive Therapy for ADHD
When a stimulant medicine isn't working, doctors will try to improve the effectiveness by adding one of the following non-stimulant drugs:
Strattera (atomoxetine). This drug is related to the antidepressants. It was the first non-stimulant approved as a solo treatment for ADHD.
Kapvay (clonidine ER). This was first used as a high blood pressure medication in its short-acting form. It was recently approved in an extended release form for ADHD.
Intuniv (guanfacine ER). Intuniv is another high blood pressure medication that is also approved to treat ADHD.
These medicines can also be used on their own in kids with ADHD.
Non-stimulant drugs work in a different way than stimulant drugs, which is why the two types of medicines are sometimes more effective when combined. Research shows that a combination of medicines is often better than one drug alone for improving children's scores on ADHD measures such as impulsivity and hyperactivity.
Side Effects of Adjunctive Therapy
Any ADHD drug can cause side effects. When these medications are combined, side effects can include:
Changes in heart rate and other heart problems also have been reported with some of these medicines.
Researchers still need to learn more about the safety and effectiveness of combining stimulants with other types of medications to treat ADHD. They are studying these different combinations in clinical trials.
If your child has side effects that he or she can't tolerate, contact your pediatrician or psychiatrist immediately. The doctor may suggest stopping the drug or changing the dose.