Medications can be an important part of treatment for ADHD (attention deficit hyperactivity disorder). There are more than a dozen ADHD medications, which gives parents a lot of options. But not every child responds to medicine in the same way.
The first ADHD medicine your child takes might not help, or it could cause side effects. Then you and your child's doctor will work together to fine-tune the medicine, schedule, and dose. It could take a few tries to find the combination that works best.
Here are some of the most common ADHD med problems and their solutions.
It's Not the Right Medicine
About 80 percent of kids who try a stimulant medicine see an improvement in symptoms. That means 1 in 5 kids won't get any benefit.
Half of kids who do improve on stimulants do just as well with any of these drugs. Other kids respond better to one type of stimulant than another.
Stimulant drugs start to work quickly. If a medicine is going to work, you should see some improvement within 30 to 90 minutes after your child takes it. That also means that if a medicine isn't helping your child, you'll notice pretty soon. Then you can go back to your child's doctor to ask for something else.
Non-stimulants take longer to work. The effects of atomoxetine (Strattera) might not kick in for 4 to 6 weeks. You'll want to give the medicine enough time to take effect before asking the doctor for a different medicine.
The Dose Is Wrong
ADHD meds come in a variety of doses, but there's no standard dose for a child's age, weight, or height. Instead, doctors usually do a medicine trial. They start kids on a low dose and then monitor them to see how they respond.
If you don't see any changes in your child, the dose may have been too low. After 3 to 7 days without any symptom improvement, your doctor can bump up the amount.
Side effects can be a sign that the dose is too high. In that case, the doctor can lower the amount of medicine.
Don't be surprised if your child has to try a few different doses to find the one that helps with their symptoms but doesn't cause side effects. They might need another change to the dose as they grow and their body gets used to the medicine.
The Timing Is Off
Stimulant meds come in two forms. Short-acting stimulants start to work within 10 to 15 minutes. Their effects last for about 4 hours. Long-acting stimulants last between 6 and 12 hours.
Some kids take long-acting stimulants to get them through the school day. They may prefer these medicines because they have a steadier effect, with fewer ups and downs during the day than short-acting meds. For other kids, the medicine's effects wear off before the end of the day.
One way to find out whether the medicine timing is off is by tracking your child's doses. Write down:
- What time they took the medicine
- How long it took the med to start working
- When it stopped working
Then work with the doctor to adjust the timing. For example, if the medicine wears off too early at school, your child might take it right before they leave in the morning or get it from the nurse later in the morning. If they can't concentrate on homework at night, you could add a dose of a short-acting stimulant after school.
You're Using a Generic Instead of a Brand Name
About 90 percent of stimulant drug prescriptions are filled with generic medicines. Generics are designed to have the same active ingredients, quality, effectiveness, and strength as the brand-name versions. And because generics often cost less, they could save you money.
But even though generics are very similar to brand-name drugs, they're not exactly the same. Some kids are sensitive to even tiny differences between brands.
Sometimes there's a bigger difference between the brand name and generic. The FDA has been trying to pull two generic versions of methylphenidate hydrochloride from the market because they don't work the same as the brand-name drug Concentra.
If a generic doesn't work well for your child, you can ask the doctor to switch your child to a different generic or to the brand-name version.
It Causes Side Effects
ADHD medicines improve focus and attention by boosting levels of the brain chemicals dopamine and norepinephrine. Bumping up the levels of these chemicals too much can cause side effects.
Most ADHD med side effects are mild and wear off in a few weeks. In one study, just under half of kids who tried medicine had at least one side effect, but only about 20 percent of side effects were really bothersome.
The most common side effects with these medicines are:
- Trouble sleeping
- Appetite loss
- Slowed growth
- Headaches and stomachaches
- Moodiness when the medicine wears off
- Tics
Not every child will have these side effects, but if your child does, report them to the doctor.
Lowering the dose or changing the timing might help. For example, switching to a short-acting medicine that wears off earlier may help your child fall asleep at night.
It's Interacting With Other Medicines or Vitamins
ADHD drugs can interact with other medicines your child takes and cause side effects. For example, the asthma drug albuterol increases moodiness and restlessness when kids take it with a stimulant.
To prevent interactions, talk to your doctor and pharmacist each time your child gets a new prescription. Go over the whole list of medicines your child takes – even vitamins and supplements that you buy over the counter.
Figuring out the right medicine, dose, and schedule is a process that takes some patience. Give your child time to get used to any new ADHD drug. Then if you don't see an improvement, visit the doctor to discuss next steps.
With so many types of medication available, it's only a matter of time before your child finds the one that helps their symptoms.
