by Susan Cadzow, MD, Director Developmental-Behavioral Pediatrics, LIH Olivia’s Place

Children and adults with severe attentional difficulties are sometimes prescribed medications. This is generally only when their symptoms are having a significant impact on learning and general function.

Medications should only be considered after other non-pharmacological supports and strategies have been implemented and there are still major concerns that the child is functioning well below their ability level due to concentration deficits.

Before considering medications, a pediatrician will do a thorough medical history and examination. Co-existing medical conditions that might be affecting the child’s performance can be identified and treated if necessary. The evaluation will also focus on assessing the nature and the severity of the problem. Information will be gathered from parents, the child’s school, and the child him/herself if they are old enough. In some cases, another referral may be made during this process, for example, to a psychologist to undertake formal assessment of the child’s learning profile and abilities).

Regarding ADHD medications, it’s important to recognize that they are aimed at reducing specific “target symptoms,” namely hyperactivity, impulsivity, and distractibility. They generally do not have specific action in terms of behaviours such as defiance and aggression. However, there can be some positive benefits for behavior and social skills if the problems are resulting from impulsivity or poor self-regulation.

If everyone agrees that a trial of medications may be helpful and is appropriate for the individual child, generally a 1 to 2 month trial of a stimulant medication will be started as the “first line” treatment. If stimulant medications are prescribed appropriately, approximately 70-80 % of people show a beneficial response (that is, significant reduction in the target symptoms).

In general stimulant medications are very safe and have been in use since the 1980s for treating children with ADHD. Reduction in appetite during the day is a common side effect of stimulant treatment. Children must be monitored carefully to ensure intake is adequate and growth is not affected. The pediatrician will follow up on a regular basis to assess dose adequacy, ongoing effects, and side effects. ADHD medications do act on chemical transmitter levels in the brain so there are many other possible side effects involving the neurological system but fortunately these are very rare and normally immediately reversible when the medications are stopped.

Since the main time that the medication effects (improved concentration, planning, and focus) are needed is the school day many families choose to not give the medication on weekends and school holidays. If for any reason stimulant medication is not effective or not well tolerated there are some alternate medications that can be tried. For example, Strattera (atomoxetine), is one that is often used and which is also available in China. Occasionally this may be tried first, particularly in children with significant anxiety symptoms as it also has an anti-anxiety effect.

Key Points

1. ADHD medications should normally be considered only in children with severe symptoms who have already tried non-medication therapies.
2. Medications are only part of the treatment plan for children with ADHD. Behaviour management, school support, classroom strategies, and counselling are also very important.
3. Children need to be assessed thoroughly before a trial of medications and monitored closely during treatment.
4. The main aim of medication is to reduce specific target symptoms in order to allow the child to reach their learning potential. Improvements in social skills and relationships may be seen if impulsivity and self-regulation have been a problem.
5. Approximately 70-80% of people with a diagnosis of ADHD respond positively to treatment with stimulants.
6. Stimulant medications have been used in ADHD since the 1980s and are well-researched and generally very safe.