Share
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, affecting an estimated 7 million children in the U.S. alone. Behavioral therapy and lifestyle changes are crucial components of ADHD management. However, when the symptoms related to ADHD are impairing and interfering with daily functioning, medication remains a cornerstone of treatment for many children, often helping them to focus, reduce hyperactivity, and improve impulse control.
There are two primary categories of ADHD medications: stimulants and non-stimulants.
Stimulants are the most commonly prescribed medications for ADHD and include two primary classes: methylphenidates (MPH) and amphetamines. In my practice, I prioritize MPH (Ritalin, Concerta, Focalin, Daytrana, Metadate CD, Methylin, Quillivant XR, and Quillichew ER) as the first-line treatment for most children with ADHD. Research consistently shows that methylphenidate is often highly effective at reducing core symptoms and is generally well-tolerated. Side effects, such as appetite suppression, tend to be temporary and manageable. For many families, timing the medication around meals minimizes this issue and ensures children maintain proper nutrition. While results can vary on a case-by-case basis, methylphenidates and amphetamines have demonstrated significant efficacy in reducing core symptoms like inattention, hyperactivity, and impulsivity.
When methylphenidate is not sufficient or tolerated, I turn to amphetamines, such as Adderall, Dexedrine, and Vyvanse. These medications are slightly more potent and can be particularly effective for children who don’t respond well to methylphenidate. However, amphetamines often come with a slightly higher risk of side effects, including sleep disturbances and irritability, which require close monitoring. Despite this, their strong efficacy often makes them a reliable second-line option.
While stimulant medications are the most widely used treatment for ADHD, they are not the right fit for every child. Some children experience intolerable side effects, such as appetite suppression, sleep disturbances, or increased anxiety, while others may have medical conditions that make stimulant use risky. For these children, non-stimulant medications often offer an effective alternative.
Non-stimulant ADHD treatments work differently from stimulants, targeting brain chemicals like norepinephrine instead of dopamine. The most commonly prescribed non-stimulant medications for ADHD include Atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor (NRI). Strattera aims to improve focus and impulse control. It is often preferred for children with coexisting anxiety or a history of tics, as it does not tend to exacerbate these conditions like some stimulants sometimes do. Two other common non-stimulant medications are Guanfacine (Intuniv) and Clonidine (Kapvay). Originally developed to treat high blood pressure, these alpha-2 adrenergic agonists aim to help regulate attention and impulsivity by affecting receptors in the prefrontal cortex. They are often particularly useful for children with ADHD and coexisting conditions such as anxiety or sleep difficulties.
