Attention-deficit/hyperactivity disorder (ADHD), a multifactorial psychological disorder, is seen in about 5% of children and adolescents (1). It occurs due to neural defects in children and can be carried into adulthood.
The treatment for children with ADHD follows a multimodal treatment structure, including behavior therapy, parent training, and medications.
In this post, we discuss the approved ADHD medications for children.
What Are The Approved ADHD Medications For Children?
- Stimulants: Formulations containing various forms of the drugs methylphenidate (Ritalin) and amphetamine (Adderall)
- Non-stimulants: Formulations consisting of the drugs atomoxetine (Strattera), guanfacine (Intuniv), clonidine (Kapvay), and Viloxazine (Qelbree). Viloxazine was approved by the FDA in 2021 for use in pediatric patients aged 6-17 (4).
How Do ADHD Medications Work?
Various parts of the brain are involved in ADHD, but the exact pathology is unknown. The function of these brain areas is controlled by an interplay of chemical messengers or neurotransmitters, namely dopamine, norepinephrine (noradrenaline), and serotonin (5) (6).
Deficiency of dopamine and noradrenaline has been closely associated with ADHD, and medications work to reestablish their balance. Based on the report of symptoms, the doctor decides the type of medication appropriate for treatment, and parents are not advised to self-medicate their child.
Stimulant drugs are the first-line medicines for treating ADHD. The word “stimulant” might make you question how a stimulant can help an already overstimulated child. Here, “stimulation” refers to the activation of the brain in a way that improves functionality, attention, and motivation and not hyperactivation in the child.
Stimulants are fast-acting drugs that increase the concentration of dopamine and noradrenaline in the brain and improve the functioning of the prefrontal cortex, thus increasing the child’s attention, self-control, motivation, and patience. They are available in tablet, capsule, oral solution, suspension, and patch forms and as immediate-release (effective for four to six hours) or extended-release (3).
The following are the approved drugs in this category.
- Methylphenidate stops dopamine and noradrenaline from being carried away from their site of action and increases their effect. Additionally, it modulates serotonin activity (1).
- Amphetamine preserves dopamine and noradrenaline at their site of action and also prevents their breakdown by metabolic enzymes (3). Methylphenidate and amphetamine are usually the first-line medications for ADHD.
- Lisdexamfetamine is a prodrug that breaks down inside the body to release amphetamine. It is a second-line medication prescribed if a six-week dose of methylphenidate has not yielded expected results (7).
- Non-stimulant medications are the second-line drugs administered for ADHD. They are available as tablets and capsules. The National Institute of Health and Care Excellence (NICE) guidelines recommend the use of atomoxetine and guanfacine only when (7) (8)
- The stimulant medications are not well tolerated by the child, or
- The child has not responded to separate six-week treatments with each of the stimulant medications.
- Atomoxetine is a drug that is classified as a “norepinephrine reuptake inhibitor.” It increases the concentration of norepinephrine and dopamine in the prefrontal cortex.
- Guanfacine and Clonidine belong to the “alpha-2 adrenergic agonist” class of drugs, and therefore, have the same action on the body. However, they differ in their potency, where guanfacine has one-tenth the potency of clonidine.
These drugs are traditionally used for high blood pressure but are found to be effective in ADHD as well. They help maintain neurotransmitter balance in the prefrontal cortex of the brain by enhancing norepinephrine activity. This improves regulation of thought, working memory, and focus.
- Viloxazine is available as extended-release capsules. It is still unclear how Viloxazine works, but it is thought to inhibit the reuptake of non-epinephrine (4).
Dosage Of ADHD Medications For Teens
Your pediatric healthcare provider may suggest a low dose and gradually increase it depending on the child’s response to the drug treatment. The following is the usually recommended dosage. However, a doctor should decide the dosage based on the individual case (3).
|Methylphenidate||2.5-5 mg twice daily to max 60mg/day||Atomoxetin||40 mg/day to max 80 mg/day|
|Dexmethylphenidate||2.5 mg to max 20 mg/day||Clonidine||0.1 mg/day to max 0.4 mg/day|
|Amphetamine||5mg twice daily to max 40 mg/day||Guanfacine||1 mg/day to max 4 mg/day|
|Dextroamphetamine||5mg twice daily to max 40 mg/day||Viloxazine||100mg/day to max 400mg/day|
Side Effects Of ADHD Medications For Children
Medications for ADHD have side effects as they target neurotransmitters. Stimulants are associated with an increase in blood pressure and heart rate. It is often not a cause for concern in most children but should be used with caution if the child has congenital heart disease or some underlying heart conditions. Thus, heart health parameters such as pulse rate, blood pressure, and heart rate are monitored before prescribing these medications in children and adolescents.
The other common side effects of stimulants may include (3)
- Stomach pain
- Loss of appetite
- Weight loss (less frequent)
Non-stimulants such as atomoxetine may also have similar side effects as stimulants but to a lesser degree.
Clonidine therapy shows side effects such as (3)
- Dry mouth.
Guanfacine’s side effects may include somnolence (drowsiness), fatigue, bradycardia (slow heart rate), and hypotension (low blood pressure).
Viloxazine can cause severe side effects, including (3)
- Increase in heart rate and blood pressure.
- Symptoms of mania.
- Suicidal ideation.
- Sleepiness and fatigue.
Precautions To Take
Take the following precautionary measures for the safe use of ADHD medications in children.
- Supervise medication use and give the prescribed medicine to the child at the correct dose and time.
- Keep the medication out of children’s reach as an overdose may have serious consequences, such as heart problems and sudden death.
- If a child misses a dose, do not give a double dose at the next scheduled time.
- Do not give the child extra medicines to carry to school. If necessary, hand them over to the school nurse or health officer.
- Do not start or stop the medications abruptly without consulting a doctor.
If a child is being treated for ADHD, the healthcare provider should be informed if the child has any underlying liver damage, kidney problems, or thyroid issues or is under medication for any other condition. Additionally, the child should be screened for any neurological disorder, including a family medical history of mental illnesses such as suicidal tendency, bipolar disorder, and depression.
ADHD medications may show interactions with other over-the-counter herbal or dietary supplement products. Thus, always consult a pediatrician for the right medication and dose for your child.
As children grow, the dose of medications for ADHD needs to be adjusted as per their age, body weight, and rate of improvement. So, follow-up visits to the doctor are crucial for ensuring correct therapy with minimum side effects. Management of ADHD yields good results when medications are accompanied by psychoeducation, social skills training, behavior therapy, and parent-training programs.