Stimulants for Attention Deficit Hyperactivity Disorder

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Stimulants for Attention Deficit Hyperactivity Disorder

Examples

Generic NameBrand Name
dextroamphetamineDexedrine
lisdexamfetamine Vyvanse
methylphenidate Biphentin, Concerta, Ritalin
mixed salts amphetamineAdderall XR

How It Works

Stimulants affect how the brain controls impulses and regulates behaviour and attention. They do this by influencing the availability of certain chemicals, called neurotransmitters, in the brain.

Why It Is Used

Stimulants are considered for people with moderate to severe attention deficit hyperactivity disorder (ADHD) who have difficulty in at least two different settings, such as school and home.3 Stimulant medicines with amphetamine, such as Adderall XR, that are used for the treatment of ADHD are approved by Health Canada for children age 6 and older. Stimulant medicines with methylphenidate, such as Ritalin, are approved for children age 6 and older. A doctor may prescribe Ritalin for a child under age 6 based on the child's specific needs.

  • Methylphenidate (such as Biphentin or Concerta) is often the preferred choice for treating ADHD, because it has fewer side effects than other medicines and generally works well to control behaviour.
  • Dextroamphetamine or the combination dextroamphetamine and amphetamine (Adderall XR) is usually the second choice when the person does not improve with methylphenidate. But either may be the preferred medicine for older children. The long-acting form of dextroamphetamine controls behaviour for a longer period of time, so fewer doses are required during the day.
  • The dextroamphetamine and amphetamine combination medicine (Adderall XR) is used when other stimulants have not improved symptoms or when the combination of medicines may be more helpful.

Stimulants may be used in people with ADHD who also have mood disorders, such as depression. The priority of which condition is treated first usually depends on which is thought to be the main disorder.

Stimulants may be used in adults when antidepressants fail to control ADHD symptoms. If antidepressants alone are not controlling symptoms, stimulants may be added.

How Well It Works

Stimulants may be the most effective treatment for the symptoms of ADHD: inattention, impulsivity, and hyperactivity. These medicines can suddenly and dramatically improve behaviour. But some people need to try different types and dosages of stimulants to find the one that works best for them. If treatment with a stimulant is successful, it usually helps control symptoms over time without increasing the dosage.3

In about 70% of people with ADHD, stimulant medicines improve symptoms.3

Children often become calmer, more organized, and less stubborn. Examples of behaviours that improve include:3

  • Less interrupting, fidgeting, and finger tapping at school; increased on-task behaviour.
  • Better relationships at home with parents and siblings; better focus and on-task behaviour; better compliance with parent requests and authority.
  • Improved social relationships; increased attention during sports and other activities.

Although stimulants may also improve social adjustment or academic performance for some children, they have not been shown to maintain this benefit over the long-term.

One study found that children with ADHD whose symptoms were predominantly related to inattention showed significant improvement when they took lower doses (36 mg or lower) of long-acting methylphenidate (Concerta) and had less benefit from higher doses. In children with ADHD who had symptoms of both hyperactivity and inattention, most showed increased improvement in symptoms when they took higher doses (36 mg to 54 mg). But higher doses resulted in increased insomnia and decreased appetite in both groups of children.2

Side Effects

The most common side effects (affecting about 50% of people) of stimulants are usually related to the dose and go away after the first 2 to 3 weeks on the medicine. Persistent side effects can usually be relieved by changing the dosage level, changing when the medicine is given, or trying a different type of stimulant. The most common side effects include:

  • Decreased appetite. About 80% of people have decreased appetite. The appetite is usually least during the daytime, increasing in the evening. If the medicine is given after meals and snacks are added, especially in the evening, it may help improve the child's appetite and prevent weight loss.
  • Difficulty falling asleep.

Other side effects are also usually temporary or go away with dosage adjustment. These include:

  • Stomach ache.
  • Headache.
  • Slightly increased blood pressure (in black males).

Long-term use of stimulant medicine appears to be safe and effective.4

Stimulant medicines may be related to slower growth in children, especially in the first year of taking the medicine. But most children seem to catch up in height and weight by adulthood. Your doctor will keep track your child's growth and watch for problems.4

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

All medicines approved for the treatment of ADHD come with a warning about possible heart-related or mental problems. Before starting a medicine for ADHD, tell your doctor if your child or you have any heart problems, heart defects, or mental health problems.

Methylphenidate and dextroamphetamine usually take effect within 1 hour after the first dose. Talk to your doctor about the best time to take the medicine.

Treatment with stimulants may be continued as long as the symptoms are present, the medicine continues to work, and there are no significant side effects.

People with ADHD do not tend to abuse stimulant medicine and very rarely develop dependence on (addiction to) on the medicine. Also, there is no evidence that people with ADHD who take stimulants are at greater risk for abusing other drugs. In fact, people who take stimulants for ADHD may be less likely to abuse drugs.1

Some people buy or steal stimulant medicines. Parents need to be certain that their child takes his or her medicine and does not share it with or sell it to anyone else. If this is a concern, talk to your doctor about your child taking a medicine in a safer form.

In 2005, Health Canada stopped sales of Adderall XR in Canada after learning that Adderall XR and Adderall (sold in the United States, not in Canada) had been linked to 20 sudden deaths and 12 strokes in children and adults in the U.S. But after carefully reviewing the data, the drug was returned to the market later that year. Talk to your doctor if you have any questions or concerns about using this medicine.

When stimulants are used to treat ADHD, remember that:

  • If a dose is missed, do not increase doses to catch up. If several doses are missed, begin taking the medicine again on the regular schedule.
  • Methylphenidate often needs to be given every 3 hours to prevent the symptoms of ADHD from coming back.

Tips for giving methylphenidate or dextroamphetamine to children:

  • It is best to start the medicine on the weekend so you can better see how the child reacts to the medicine.
  • A low dose of methylphenidate is usually given at first. The dose is increased until the child's behaviour is controlled. It is important to follow the prescribed dosage schedule and watch for changes in behaviour.
  • A typical schedule for giving the medicine is after breakfast and lunch and in the afternoon. Schedules may be changed to suit the needs of the child, his or her family, and school. It is better to give the medicine after meals rather than before so it doesn't interfere with the child's appetite and weight gain.
  • Most children who take stimulants for ADHD function best when medicines are used continuously. But some children may function well enough to take a break from medicines on weekends and holidays. Even for these children, it is usually helpful to continue the medicine on weekends if activities are planned that require concentration and attention, such as team sports, church activities, or educational programs.

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References

Citations

  1. Upadhyaya HP (2008). Substance use disorders in children and adolescents with attention-deficit/hyperactivity disorder: Implications for treatment and the role of the primary care physician. Primary Care Companion Journal of Clinical Psychiatry. 10(3): 211–221.
  2. Stein MA, et al. (2003). A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics, 112(5): e404–e413.
  3. American Academy of Child and Adolescent Psychiatry (2002). Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. Journal of the American Academy of Child and Adolescent Psychiatry, 41(2, Suppl): 26S–49S.
  4. Greenhill LL, Hechtman LI (2009). Attention-deficit/hyperactivity disorder. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3560–3572. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Specialist Medical Reviewer Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics
Last Revised June 10, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.