Which of the following is a drug that can be used to treat attention deficit hyperactivity disorder

What is attention-deficit hyperactivity disorder?

Attention-deficit hyperactivity disorder (ADHD) is a condition that affects behaviour and can make day-to-day tasks difficult.

Children and teens with ADHD may:

• have trouble paying attention,
• have trouble finishing their work,
• be impulsive or act without thinking,
• have trouble following directions,
• have trouble managing their emotions,
• struggle with transitions or changes, and
• be easily distracted.

Not everyone with ADHD is hyperactive. Some children with ADHD may be more fidgety than overly busy, and others may not be very busy at all (this is called “inattentive presentation”).

While specific symptoms differ from child to child, ADHD can lead to problems in school, with relationships (friends, family members), and with self-esteem.

ADHD often runs in families. Having a sibling, parent or other relative with ADHD increases the chance that someone will have the condition.

How can ADHD be treated?

With treatment, children with ADHD can live with and manage their symptoms. Treating ADHD can involve:

• education and skills training for parents, children and youth,
• strategies for understanding and building your child’s social skills,
• classroom management strategies and study skills,
• other interventions that don’t involve medication, and
• medicine prescribed by a doctor.

What medicines are used to treat ADHD?

Stimulants

Although they won’t cure ADHD, medications are more likely than other approaches to improve symptoms of attention, impulsivity and hyperactivity.

The most common medications used to treat ADHD are called stimulants. Stimulant medications will help improve symptoms for about 7 out of 10 children (70%) with ADHD. 

Here is how stimulants work:

• When someone has ADHD, the pathways in the frontal lobe part of the brain—which is involved in attention—aren’t working the way they should.
• Stimulants increase dopamine, a brain chemical that helps the pathways become more active.
• This increase in dopamine helps improve attention and decrease hyperactivity and impulsivity. 

Stimulant medications have been used for a long time. Doctors understand how they work and what to watch for so that they are safe and effective.   

Each of the 3 main stimulant medications has a different active ingredient:

• methylphenidate (Ritalin, Biphentin, and Concerta)
• dextroamphetamine (Dexedrine, Dexedrine spansule, and Vyvanse)
• mixed amphetamine salts or MAS (Adderall XR) 

All of these medications work in about the same way, and have similar side effects.

They come in shorter and longer acting forms. The active ingredient is the same but the form that it comes in (tablet, capsule) and the way it is released in the body are different. Your child’s doctor will choose a medication based on your child’s symptoms, other health conditions, sleeping and eating habits, and ability to swallow medicine. 

Stimulant medications are usually prescribed for a trial period (often three weeks) to see if they are right for your child. They are not addicting. The medications can be stopped if they are not helpful, or if there are side effects that don’t go away even after the dose or timing of medication has been changed.

Second-line medications

There are other medications that can be used for ADHD if stimulants are not effective or not tolerated:   

• Atomoxetine (Strattera) is a long-acting, non-stimulant medication that works throughout the day. It needs to be taken for a while (up to two months) to see if it is effective for your child. 
• Alpha-agonist medications such as clonidine (Dixarit, Catapres) and extended release guanfacine (Intuniv XR) may be good choices for children with tics, severe impulsivity or impulsive aggression.

Atypical anti-psychotic medications like risperidone (Risperdal) are NOT RECOMMENDED for “uncomplicated” ADHD because they don’t help attention that much. They may be used for children with serious disruptive behaviour and aggression, but need medical monitoring (exam and blood tests) because they have more side effects. These medications should only be used after other medications for ADHD have been tried and were not effective.

Are medications right for my child?

If your child is under 6 years old, medications are not the first line of treatment. Your doctor will recommend behavioural interventions first.

If your child is 6 years or older, here’s what you can expect your child’s doctor to do before suggesting medication:

• Review your child’s medical information, including what strategies have already been tried.
• Do a physical exam to check whether there is any reason your child should not take one of these medications.
• Measure height, weight and “vital signs” (blood pressure and pulse). These can be tracked at future visits to make sure there are no problems with the medication. No lab work is needed for stimulants.

You and/or your child’s teachers might be asked to fill out questionnaires to identify what symptoms to treat and to monitor your child’s response to the medication. 

Your family history is also important. Let your child’s doctor know if anyone in your family has:

• ADHD, and how they have responded to medication.
• health conditions such as: heart disease (especially if symptoms came early in life or affected heart rhythm); epilepsy or seizure; anxiety disorders and tics/Tourette’s. While many children with these conditions can safely and successfully use ADHD medication, they may need more monitoring by your doctor or a specialist (paediatrician, developmental paediatrician or child psychiatrist).

Are there any risks to ADHD medications?

Like many medications, stimulant medicines may have some side effects, although serious side effects are very rare.

Your doctor will assess for any risks before prescribing, monitor how your child’s medication is working, and make adjustments as needed.

Here are some of the more typical changes you might notice:

• Children often have less appetite for lunch, but usually recover for dinner. Some children may need an extra snack.
• Some children may have difficulty falling asleep. Others may sleep better because their ADHD symptoms have improved, and they have a more successful day.
• Grumpiness, irritability or strong emotions when the medication is wearing off is common, especially in the first weeks after starting it. This usually passes with time.

Common side effects can be managed by changing the timing or dose of medication or by switching to another medication. Talk to your child’s doctor if:

• Your child’s irritable mood doesn’t go away. The medication dose may need adjusting. 
• Your child seems to concentrate “too well” or stare off. This can be a sign of too much medication.

Other ADHD medications may have different side effects, which your doctor can describe.

Stimulant medications should be taken with food, which is gentler on the stomach but does not affect how the medicine is absorbed.

How can I make the right treatment decision for my child?

Most children can benefit from a combined approach to ADHD, including:

• behavioural strategies,
• an appropriate educational environment,
• healthy routines (good nutrition, sleep, physical activity, and not too much screen time), and
• medication. 

Learn as much as you can about medication so you can make an informed choice.  Ask your doctor about anything that is confusing or worrying. 

What else can I do to help my child?

• Become informed. Find out all you can about all aspects of ADHD.
• Find out about mental health services in your area, including parent programs, groups for kids, and individual interventions to learn ways of helping with ADHD symptoms.  Psychologists, behaviour specialists, mental health therapists, and some physicians are able to help coach families with effective behaviour strategies.
• Advocate for your child.  You may need to help your child’s teacher understand ADHD and what is being recommended to help your child. Teachers will help put in place the educational aspects of your child’s ADHD treatment plan. Their observations can also be helpful when children are trialing or adjusting medication.

There is good information for parents in the resources below.

More information from the CPS

• Non-prescription interventions for attention deficit hyperactivity disorder
• A parent’s guide to health information on the Internet
• ADHD in children and youth: Part 1—Etiology, diagnosis, and comorbidity (position statement)
• ADHD in children and youth: Part 2—Treatment (position statement)
• ADHD in children and youth: Part 3—Assessment and treatment with comorbid ASD, ID, or prematurity (position statement)

Reviewed by the following CPS committees

• Mental Health and Developmental Disabilities Committee