Navigating an ADHD Diagnosis and Medicines in Children

Has your child been diagnosed with attention deficit hyperactivity disorder (ADHD)?

Are you evaluating ADHD treatment like medications and therapy for your loved one?

Know that you are not alone, and that ADHD is one of the best studied child psychiatry conditions, so we have plenty of information to share below to help!

What we know:

Children as young as age 3 can be reliably diagnosed and treated for ADHD. Under age 6, the first line treatment for ADHD is behavioral therapies and parent child interaction training (PCIT). However, in severe cases or cases in which therapy is not enough or readily available, we have good, long-term studies and real-world experience to support the use of a variety of ADHD medications.  These medications can be extremely effective at managing their symptoms. ADHD medications such as stimulants, like Ritalin and Adderall are the most effective. Other common medications include guanfacine, clonidine, and Strattera are often prescribed as well, and while not as potent as stimulants, they can be very helpful in the right child.

These medications do not cure ADHD.

Instead, they help the brain make more and better use of brain chemicals such as dopamine and norepinephrine. Dopamine allows for better focus and attention. While not everyone with ADHD needs medicine it can help most people with ADHD stay focused and listen better. What about therapy and ADHD medications? Are ADHD medications safe for your child?

Co-existing Disorders plus ADHD and Medication Effectiveness:

Research has shown that ADHD often has co-existing disorders:

• Oppositional defiant disorder 
• Learning disabilities 
• Dyslexia
• Auditory Processing Disorder

These disorders may impact the effectiveness of the medication. Children with fewer coexisting disorders are most likely to respond to medication treatment alone, whereas the kids with more mental health disorders do not always respond as strongly to taking ADHD medication alone. Cognitive test scores and ADHD symptoms often improve within the first year for children and adolescents with ADHD, including if they have autism and other comorbidities.

Therapy and ADHD Medicines in Preschoolers:

It is well known that under the age of 6, a significant number of children diagnosed with ADHD respond well to behavioral therapy programs. Early behavioral interventions can reduce symptoms of ADHD in preschoolers. After the age of 6, research shows that children respond more quickly and robustly to medications than therapy alone. 

The largest and most comprehensive treatment study of ADHD, the Multimodal Treatment Study of Children, found that in children over age 6, medications dramatically assist with managing inattention and hyperactivity/impulsivity. Compared to therapy alone, primary ADHD symptoms were much better managed at home and in the classroom with medication.

ADHD Medications Can Benefit Children:

• ADHD medication significantly reduces risks for several negative outcomes, including….
• Academic impairments
• Mood disorders
• Criminality 
• Substance Use Disorders
• Accidents
  
  

How Stimulants Work in the brain

Many parents may wonder how their child’s ADHD medication works. When your child takes low doses of stimulant medication for ADHD, it helps their brains produce more and make the most out of dopamine, and norepinephrine. These brain chemicals are known for playing a critical role in attention, focus and impulse control. ADHD is known for having low dopamine in the front part of the brain, which can make kids impulsive, hyper, and risk taking. Depending on the medication, your child’s dopamine and or norepinephrine levels in the frontal cortex will be increased and more steady throughout the day. This improves brain cell communication and function. There are even some studies showing increased brain cell growth in certain parts of the brain, known as “white matter”, in boys who take ADHD medication.  While changing the level of dopamine in the brain changes the way it functions on medications, standard doses, taken as prescribed, are not nearly high enough to produce euphoria and are not considered addictive.

What Are The Side Effects and Risks?

The FDA approves stimulants for use in children as young as three years of age. The three studies funded by the FDA examining cardiovascular safety in over 3 million children, adolescents, and adults found no increased cardiovascular risk while taking stimulants for ADHD. 

The most common side effects of ADHD medication: 

• Insomnia (sleep problems)
• Stomach aches
• Social withdrawal/ Mood problems
• Hyperfocus
• Rare tics
• Appetite loss

Most commonly, side effects decrease with continued treatment. However, low appetite and trouble sleeping can last longer. If ADHD stimulant medications are prescribed, it is essential to work closely with a doctor who can assist in managing any side effects that may arise.