Children with ADHD: A pharmacist/mom’s perspective

Children with ADHD or Childhood ADD:

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and into adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). The prevalence of ADHD among children is around 11%, and the average age that children are diagnosed is 6 years old. Boys are about 3 times more likely to be affected by ADHD than girls. It’s estimated that about 70% of children diagnosed with ADHD take medication to control their symptoms.1

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*Additional information about ADHD can be found here on the National Institute of Health website.

ADHD Medication for Children:

The 2 classes of medication used to treat ADHD include stimulant medications (amphetamines and methylphenidates) and nonstimulant medications.

The American Academy of Pediatrics recommends starting with any FDA-approved drug.

However, because stimulants have been available for longer, there are more studies supporting their use. Stimulants are effective in most children and are therefore typically used first. The age of your child will guide the drug and therapy choice.

  • For children 4-5 years old, behavior therapy is recommended as first-line treatment; drug therapy with methylphenidate is an option if behavior therapy isn’t enough.
  • For children 6-18 years old, drug and/or behavior therapy is recommended, and the use of both is preferred.

Either a methylphenidate or an amphetamine medication may be chosen as a first-line option. Starting with a low dose and slowly increasing the dose is highly recommended to balance efficacy and side effects. If the medication is not effective for your child or unmanageable side effects occur, the other type of stimulant or a nonstimulant medication can be tried next.

Nonstimulants may be tried first if abuse or diversion concerns exist or if you strongly prefer not to start with a stimulant drug.

ADHD Medication Side Effects:

The most common side effects with stimulant medications include:2

  1. Loss of appetite (up to 36%)
  2. Insomnia or difficulty sleeping (up to 31%)
  3. Dry mouth (up to 35%)
  4. Anxiety or irritability (up to 8%)

These side effects are often dose-related, with the higher the dose the more likely the side effect. Of note, these side effects go away after stopping the medications.

The most common side effects of the non-stimulants are more difficult to generalize, since each of them work in different ways. However, they do not tend to have the same side effects as the stimulants. So, if your child cannot tolerate a stimulant, it makes sense to switch to a non-stimulant.

My Personal Take:

As a mom and a pharmacist, here’s my personal take on the diagnosis and treatment of ADHD.

Medicating a child with a stimulant for lack of attention will technically work to increase attention in anyone – with or without an underlying diagnosis of ADHD. This is why Adderall is so popular among college students – it helps them to focus, pull all-nighters and party harder. It works.

Furthermore, ADHD can be misdiagnosed in children who actually suffer from anxiety, have a learning disability like dyslexia, or have a stressful home environment. This may be why non-stimulant medications don’t seem to work as well as the stimulant medications, because these medications will not work if a patient doesn’t actually have ADHD.

If your child is currently taking a medication and doesn’t seem to be improving, this could be because they’ve been misdiagnosed. This is why I recommend starting with behavior therapy counseling first. The counselor will be able to further evaluate your child’s symptoms and help your child to develop valuable coping strategies to stay focused, which they can then use going forward.

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If you found this helpful, you may want to check out the following:

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References:

1. NIH. Attention-Deficit/Hyperactivity Disorder (ADHD). 2017.
https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd.shtml

2. Elsevier. Clinical Pharmacology. 2018.

Kristen Engelen, PharmD
Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.