Kids Health Info

ADHD - Stimulant medication

  • Attention Deficit Hyperactivity Disorder (ADHD) is a developmental problem which results in poor concentration and control of impulses. It can affect children's learning and social skills and also family functioning. Follow the links at the end of this factsheet to find more information about ADHD.

    Medication and treatment

    The single most effective treatment for the symptoms of ADHD is stimulant medication. Stimulants have been used for more than 50 years, and became standard treatment for children with ADHD in the 1980s. Approximately one to two children in every 100 are prescribed stimulant medication.

    The stimulants available in Australia are methylphenidate and dexamphetamine. Both have similar actions and side effects. Another more recent type of medication is called atomoxetine (Strattera).

    How do stimulants work?

    Stimulants act on the parts of the brain involved in self-control. This helps focus attention, and may also help filter out unnecessary information. Stimulant medication is probably the most highly researched of any medication prescribed for children. They greatly improve concentration, impulse control and overactivity in about eight children in every 10 with ADHD.

    What types of stimulants are available?

    • Short-acting forms of stimulants (e.g. Ritalin 10, Attenta, dexamphetamine).
    • Long-acting forms of stimulants (e.g. Ritalin LA and Concerta) and atomoxetine (Strattera).

    All the above stimulants are available in Australia on the government Pharmaceutical Benefits Scheme (PBS), and the cost is the usual prescription fee or health care card holder fee.

    The short acting forms last three to four hours. Ritalin LA lasts six to eight hours and Concerta 10-12 hours.

    In Australia, stimulant medication can only be prescribed by paediatricians, child psychiatrists or neurologists (and sometimes GPs in certain situations). These medications are regulated.  This means the prescribing doctor needs to apply for a permit from the state health department.

    Side effects

    The main side effects of stimulants are:

    • decreased appetite
    • poor weight gain.


    Less common side effects include:

    • stomach aches
    • headaches and dizziness
    • difficulty falling asleep
    • occasionally a child treated with stimulant medication becomes irritable, withdrawn or highly emotional.

    If side effects occur with stimulant medication, they are usually seen soon after starting and can often be managed by changing the dose or the time that the medication is given. If more intense side effects occur, the medication can be stopped immediately without needing to slowly reduce the dose. Many children will have no side effects at all.

    The stimulants are not addictive in the doses used to treat ADHD. Studies have shown that children with ADHD treated with stimulant medication are less likely to have problems with drug abuse in their teenage years than children who are not treated, probably because they are more settled and less likely to take risks.

    It is possible that stimulants may have a minor effect on some children's growth, so this needs to be monitored. However, in practice it is rarely a problem.

    No other long-term effects have been identified.

    Effects on the blood pressure and heart

    Stimulant medication may cause a very small increase in both heart rate and blood pressure in both children and adults. This is extremely unlikely to cause any problems for children with normal hearts. In certain situations children may require a heart evaluation before starting stimulant medication:

    • Children with a known heart or blood vessel abnormality.
    • Family history of sudden unexplained death under 40 years of age.
    • Family history of heart muscle or heart rhythm problems.

    Monitoring

    Children taking stimulant medication should be monitored by their treating doctor. This should happen regularly in the early phase of treatment, and at least every six months while the child is taking stimulants. In particular, height, weight, heart rate and blood pressure should be checked.

    Non-medication treatments

    Medications are only one part of a treatment package for children with ADHD. Other treatments include behaviour modification, classroom strategies to improve concentration and learning, and sometimes individual or family counselling.

    Key points to remember

    • Stimulants have been used by children with ADHD for more than 50 years. About one to two of every 100 Australian children are taking stimulant medication.
    • Any side effects from stimulant medication can usually be controlled with changes to the dose, strength and timing.
    • Children still need to see the prescribing doctor at least every six months.
    • Stimulant medication is just one part of treatment for ADHD. Behaviour modification, classroom strategies and sometimes counseling is also needed.

    For more information

    Developed by the RCH Centre for Community Child Health and RCH Pharmacy. First published  2006. Updated November 2010.

Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts.