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ADHD in Children Health Center

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Choosing the Right ADHD Medication for Your Child

You have many options in types of medications, doses and treatment strategies.

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These stimulants are generally considered safe medications with few side effects, the AAP states in its guidelines. The side effects occur early in treatment and tend to be mild and short-lived. The most common are: decreased appetite, stomachache or headache, difficulty falling asleep, jitteriness, or social withdrawal. Most of these symptoms can be successfully reduced by adjusting the dosage or the time of day the child takes medication. From 15% to 30% of children develop tics while taking stimulants. This is a short-term side effect that goes away when the child stops taking stimulants.

Perhaps the biggest advance in ADHD stimulants is that newer versions are available in long-acting form. Here, briefly, are the pros and cons of various forms of stimulants:

Long-Acting Stimulants

Adderall XR amphetamine 10-12 hours
Concerta methylphenidate 10-12 hours
Dexedrine spansule amphetamine 8-10 hours
Methylin ER methylphenidate 6-8 hours
Metadate ER methylphenidate 6-8 hours
Metadate CD methylphenidate 8 hours
Ritalin SR methylphenidate 6-8 hours
Ritalin LA methylphenidate 8 hours

Because the effects of some of these drugs can last up to 10 or 12 hours, a child can take one pill in the morning, and not worry about taking another at school. Longer-acting stimulants may also help children get through after-school activities. Some children, however, may need a second dose or a shorter-acting form of a different drug if afternoons and evenings are challenging.

Short-Acting Stimulants:

Ritalin amphetamine 3-4 hours
Focalin amphetamine 3-4 hours
Adderall amphetamine 4-5 hours
Dexedrine amphetamine 4-5 hours
Dextrostat amphetamine 4-5 hours

These are usually taken at three- to four-hour intervals -- usually about 30 minutes before the earlier dose wears off. This means that children have to take the pills at school, either at lunchtime or another time during the day. At some schools, this is not always easy to coordinate. Often there is not a school nurse on site to give the medication, and children are not allowed to keep their own pills.

But short-acting drugs do help control many children's ADHD symptoms. Often, children might take a short-acting stimulant in the afternoon -- after the longer-acting stimulant wears off - so they can participate in after-school activities or have quieter evenings at home.

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