Good Child Guide
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What are stimulant medications?

Methylphenidate (Ritalin, Equasym, and the new long acting Concerta XL) and dextroamphetamine (Dexedrine, Adderall (also contains levoamphetamine),and Adderall XR (long acting)) are sometimes called “stimulants”. When prescribed for people who have attention-deficit hyperactivity (ADHD) they stimulate parts of the brain which aren’t working as well as they should. They are not tranquilisers or sedatives.

How can these medicines help?

They can improve attention span, decrease distractibility, increase ability to finish tasks, improve ability to follow directions, decrease hyperactivity, and improve ability to think before acting (decrease impulsivity). Legibility of handwriting and completion of school work and homework can improve. Aggression and stubbornness may decrease in youngsters with ADHD

Stimulant medication is not the only answer, nor the whole answer, for ADHD! The medicine works best when used together with special help in school and behaviour modification procedures at home and school. Some youngsters and families also benefit from individual, family, or group psychotherapy. If stimulant medications do not help, or cause side effects that are a problem, you can discuss other medications with the doctor.

How long does the medicine last?

Methylphenidate (Ritalin, Equasym) usually lasts about 3-4 hours, dextroamphetamine (Dexedrine) about 5-6 hours, and Concerta XL about 10 hours.

How will my doctor monitor this medicine?

From time to time the physician (or nurse) will check height and weight, and possibly pulse and blood pressure. your doctor will ask for regular reports from your child’s teacher(s) to check on learning and behaviour.

What side effects can this medicine have?

Any medication may have side effects, including allergy to the medication. Because each patient is different your doctor will work with you to get the most positive effects and the fewest negative effects from the medication (see the next page). This list may not include rare or unusual side effects. Please talk to your doctor if you suspect the medicine is causing a problem. If at any time you are alarmed about any side effect, simply stop the medication and then discuss it with your key worker.

Common side effects:

These often go away after about 2 weeks, or if the dose is lowered:

  • Lack of appetite – encourage a good breakfast, and afternoon and evening snacks; give medicine after meals rather than before.
  • Trouble falling asleep – see suggestions in my article on sleep problems.
  • Headaches.
  • Stomach aches.
  • Irritability, crankiness, crying, emotional sensitivity, staring into space.
  • Loss of interest in friends.
  • Rapid pulse or slightly increased blood pressure. This is only very rarely of any clinical significance.
  • Rarely, as the medicine wears off, hyperactivity or bad moods get worse than before the medicine was started. This is called “rebound“. A small dosage adjustment may help this problem.
  • A very few children may not grow quite as fast as usual. This is why the height and weight are checked regularly. Growth usually catches up if the medicine is stopped.
  • Occasionally nervous habits (like picking at skin) or stuttering may appear.

Serious side effects:

tell your doctor right away:-

  • Muscle tics or twitches, jerking movements
  • Sadness which lasts more than a few days
  • Any behaviour which is very unusual for your child

What could happen if this medicine is stopped suddenly?

There are no medical problems in doing this. A few youths may experience irritability, trouble sleeping or increased hyperactivity for a day or two if they have been on daily medication for a long time, especially at above average doses. Sometimes it is better to stop the medication gradually, over a week or so.

How long will this medicine be needed?

There is no way to know how long a person will need to take the medicine. The parent, the doctor/nurse, school, and of course the child, will work together to find out what is right for each young person. Sometimes the medicine is needed for only a few years, but some people may need help from medicine even as adults. Much depends on what else you do to help your child to succeed in school and in life.

What else should I know about this medicine?

Many people have incorrect information about this medicine. If you hear anything that worries you, please check with your doctor/nurse.

This medicine does not cause illegal drug use or addiction.

This medicine does not stop working at puberty.

Some young people take the medicine three or four times a day, every day. Others only need to take it twice a day and only on school days. You and your doctor will work out what is best.

If the medicine seems to stop working, it may be because it is not being given regularly (especially at school), because your child has gained weight and needs a higher dose, or because something at school or at home, or in the neighbourhood, is upsetting your child. First try to work out if there has been some change at home or school that might be upsetting your child in some way. If the problems still continue, then you may need to adjust the dosage of the medication and so should discuss your concerns with your doctor. Remember, however, the doctor does not have all the answers to your problems! He or she can only work with you to help you to find the solutions that are best for you.

The combination of this medicine with antidepressant medications like Tofranil (imipramine) or Allegron (nortriptyline) may cause irritability and confusion, or severe problems with emotions and behaviour such as fighting and hallucinations. However, there may be times when it may be helpful to use the two medicines together, very carefully. This should be done only under specialist supervision.

It is not a good idea to combine this medicine with nasal decongestants (medicines containing pseudoephedrine or related medicines), because rapid pulse or high blood pressure may develop. If nasal congestion is severe it is better to use a nasal spray. Check with the pharmacist before giving any over-the-counter medicine. Also, many children with ADHD become cranky or more hyperactive on antihistamines (like Benadryl). If medicine for allergies is needed, ask for one of the antihistamines that does not enter the brain (like Seldane or Hismanal).

Dr. Noel Swanson, Consultant Child Psychiatrist and author of The GOOD CHILD Guide, specializes in children's behavioural difficulties and writes a free newsletter for parents. He can be contacted through his website on Expert Parenting Advice.

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