ADHD Medications for Children: What to Know
Medically reviewed by Mary Choy, PharmD
Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed neurological condition. It affects more than 8% of children and 2.5% of adults.
In children, ADHD can impact many aspects of everyday life, including school, daily functioning, and interpersonal relationships.
The treatment of ADHD in children generally involves several factors, including medication, psychotherapy, and educational interventions.
Some common medications used to treat ADHD include Adderall (mixed amphetamine salts) and Ritalin (methylphenidate).
This article will analyze commonly prescribed ADHD medications for children and explain their uses, dosing requirements, potential side effects, administrative methods, and more.
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Treating ADHD in Children
According to parent reports gathered for the National Survey of Children's Health (NSCH) based on data from 2003 to 2011, the median age of ADHD onset is 6 years old. However, more severe cases tend to be diagnosed earlier.
Data from the NSCH also found that:
For those with severe ADHD, the median age at diagnosis is 4 years old.
For those with moderate ADHD, the median age at diagnosis is 6 years old.
For those with mild ADHD, the median age at diagnosis is 7 years old.
About 33% of children who have ADHD will continue to have ADHD into adulthood.
In children, ADHD treatment depends on their age.
For children younger than 6 years old, healthcare providers will recommend parent training in managing behavior as the first treatment before prescribing medication.
For children 6 years and older, healthcare providers will recommend a combination of both medication and behavioral therapy, including educational intervention.
For children with ADHD, symptoms can significantly affect the quality of life, especially in school. ADHD can affect many aspects of school life, including completing schoolwork or homework and navigating social relationships.
Medications used for ADHD in children include stimulant and non-stimulant medications. The following content will provide more information about medication options for ADHD treatment in children. This information is a general overview.
For more information and medical advice, consult your child's healthcare provider.
Symptoms and Types of ADHD
Symptoms of ADHD in children may include:
Inattention: Having trouble focusing, staying on task, or staying organized
Hyperactivity: Moving around constantly, even when it is not appropriate to do so; excessively fidgeting, tapping, or talking
Impulsivity: Acting without thinking; having difficulty with self-control; interrupting others
The three types of ADHD are:
Predominantly inattentive (having symptoms of inattention)
Predominantly hyperactive/impulsive (having symptoms of hyperactivity and impulsivity)
Combined (having symptoms of inattention, hyperactivity, and impulsivity)
What Are Stimulants?
Stimulants are considered first-line medications (the first choice of treatment) for children with ADHD.
These medications contain various forms of amphetamine or methylphenidate and have a calming effect. They work by increasing levels of dopamine and norepinephrine in the brain.
Dopamine and norepinephrine are neurotransmitters (chemical messengers) that help with motivation, movement, focus, and attention.
Stimulants are classified by the Drug Enforcement Agency (DEA) as Schedule II drugs because they carry a high risk for misuse, abuse, and addiction.
Short-Acting vs. Long-Acting Stimulants
Children may be treated with a short-acting stimulant, a long-acting stimulant, or a combination.
Short-acting stimulants begin to take effect quickly after consumption. Furthermore, because their effects last only a few hours, one or two additional doses may be needed throughout the day.
Long-acting drugs require once-daily dosing. A once-daily dose provides a treatment that lasts for the entirety of the day.
This may help with convenience and help avoid trips to the nurse at school for additional doses, although some children will need both a long-acting and a short-acting stimulant.
The choice of short-acting or long-acting stimulants (or both) will depend on individual factors. Contact your child's healthcare provider for more information and medical advice.
Amphetamine vs. Methylphenidate Medications
There are two types of stimulants: amphetamines, such as Adderall, and methylphenidates, such as Ritalin.
They work in slightly different ways, but for both types of drugs, the result is an increase in dopamine and norepinephrine, which helps improve ADHD symptoms.
For the selection of a first-choice ADHD medication, experts recommend using a methylphenidate product in children and adolescents and an amphetamine product in adults.
However, this is not always the case, as some children have better results with amphetamine medication. Healthcare providers will consider many factors when determining the best drug for each individual.
Also, healthcare providers prescribe these medications at the lowest effective doses.
Short-Acting Amphetamine Stimulants
A notable example of a short-acting amphetamine stimulant is Adderall immediate-release (IR), which contains mixed amphetamine salts, otherwise known as amphetamine/dextroamphetamine.
This medication is Food and Drug Administration (FDA)–approved to treat ADHD and narcolepsy (a medical condition characterized by overwhelming daytime drowsiness). Adderall IR is available as a tablet that can be taken by mouth.
Adderall IR is a brand-name drug and is also available in generic form.
Adderall IR Dosing Guidelines
Standard dosing guidelines regarding the use of Adderall IR for the following conditions and age groups are:
ADHD children 3–5 years old: Start with 2.5 milligrams (mg) once daily. From there, a healthcare provider will increase the dose slowly, if needed, to an effective dose.
ADHD in children 6 years old and older and in adults: Start with 5 mg once daily or twice daily. From there, the healthcare provider will increase the dose slowly, if needed, to an effective dose. The total daily dose will usually be 40 mg or less. The first dose is given when the child wakes up, and one or two additional doses can be given in four- to six-hour intervals.
Narcolepsy in adults and adolescents 12 years and older: 5-60 mg per day is given in divided doses. The starting dose is usually 10 mg once daily, and the healthcare provider will increase the dose slowly, if needed, to an effective dose.
Narcolepsy in children 6–12 years old: The starting dose is usually 5 mg once daily, and the healthcare provider will increase the dose slowly, if needed, to an effective dose.
Long-Acting Amphetamine Stimulants
Examples of commonly prescribed long-acting amphetamine stimulants are Adderall XR (extended-release, or ER, mixed amphetamine salts) and Vyvanse (lisdexamfetamine).
Adderall XR
Adderall XR comes in capsule form to be taken by mouth. Adderall XR is FDA-approved to treat ADHD.
Adderall XR, a brand-name drug, is also available in generic form.
Standard dosing guidelines regarding the use of Adderall XR for ADHD in children 6-17 years old include:
The initial dose is 10 mg, taken once daily in the morning.
The healthcare provider will increase the dose slowly, if needed, to an effective dose.
The maximum dose for this age group is 30 mg once daily.
Vyvanse
Vyvanse is a long-acting amphetamine stimulant that contains the ingredient lisdexamfetamine.
It is given as an oral capsule or chewable tablet.
Vyvanse is FDA-approved to treat ADHD in adults and children, as well as moderate to severe binge eating disorder (BED) in adults.
Vyvanse is a brand-name drug and is also available in generic form.
Standard dosing guidelines regarding the use of Vyvanse for ADHD in children 6 years and older, as well as adults, include the following:
The starting dose is 30 mg, taken once daily in the morning.
The healthcare provider will increase the dose slowly, if needed, to an effective dose.
The maximum dose is 70 mg once daily.
Potential Side Effects: Amphetamine Stimulants
Stimulants carry black box warnings, the most severe warning granted by the FDA.
The warning states that amphetamine stimulants possess a high potential for abuse and misuse, which can lead to substance use disorder.
In general, potential users should understand that the misuse and abuse of stimulants can cause overdose and death.
Before prescribing a stimulant, the healthcare provider will consider the individual's risk for abuse, misuse, and addiction.
The provider will also educate individuals and their families about drug risks and how to store and dispose of the medication properly.
During treatment, the individual will be closely monitored for symptoms of abuse and misuse.
Common Side Effects
Common side effects associated with the use of amphetamine stimulants include but are not limited to:
Stomach problems, such as nausea, vomiting, diarrhea, and stomach pain
Contact your healthcare provider right away if you have serious side effects.
Dial 911 if your symptoms feel life-threatening or if you think you are having a medical emergency.
Severe Side Effects
In addition to the black box warning mentioned above, severe side effects associated with the use of amphetamine stimulants can include but are not limited to the following:
Anaphylaxis (severe allergic reaction), seek emergency medical attention if you experience urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
Sudden death (in people who have severe heart disease)
Increased heart rate
Increased blood pressure
Manic episodes (a significantly elevated, excitable mood)
Issues with blood circulation
Growth suppression in children (children who take stimulants will be closely monitored for growth)
Short-Acting Methylphenidate Stimulants
Notable examples of short-acting methylphenidate stimulants include Focalin (dexmethylphenidate) and Ritalin (methylphenidate).
Focalin
Focalin is FDA-approved to treat ADHD and is given as an orally administered IR tablet.
Focalin is a brand-name drug that is also available in generic methylphenidate.
Standard dosing guidelines regarding the use of Focalin for ADHD in children 6 years and older include the following:
For children who do not currently take methylphenidate or who take another stimulant, the starting dose is 2.5 mg twice daily.
For children who currently take methylphenidate, the starting dose is half of the total daily dose of methylphenidate.
The healthcare provider may slowly increase the dose, if needed, to 10 mg twice daily.
Focalin should be taken twice daily, at least four hours between doses.
Ritalin
Ritalin is FDA-approved to treat ADHD and narcolepsy. It is given as an orally administered IR tablet.
Ritalin is a brand-name drug and is also available in generic form.
Standard dosing guidelines regarding the use of Ritalin for ADHD in children 6 and older include the following:
The starting dose is 5 mg twice daily before breakfast and lunch.
The healthcare provider will gradually increase the dose to an effective dose if needed.
The maximum dose in this age group is 60 mg per day.
For those who have trouble sleeping with Ritalin, it is recommended to avoid taking Ritalin after 6 p.m.
Long-Acting Methylphenidate Stimulants
Some examples of long-acting methylphenidate stimulants include Concerta (methylphenidate), Quillivant XR (methylphenidate), and Jornay PM (methylphenidate).
Concerta
Concerta is FDA-approved to treat ADHD in children 6 and older, as well as adults up to age 65 years old, and is given as an oral ER tablet.
ER Concerta is a brand-name drug and is also available in generic form.
Standard dosing guidelines regarding the use of Concerta for ADHD in children include the following:
For children and adolescents who have not taken Concerta before, the starting dosage is 18 mg once daily.
The healthcare provider may gradually increase the dose if needed to a maximum dose of 54 mg daily for children or 72 mg daily for adolescents.
For individuals taking Concerta, the healthcare provider will consider multiple factors to determine a proper dosage.
Concerta is taken once daily in the morning. The pill should be swallowed whole with a glass of water. It can be taken with or without food.
Concerta should not be crushed or chewed.
Quillivant XR
Quillivant XR is FDA-approved to treat ADHD and is available as a suspension that is given as an oral ER liquid suspension.
Quillivant XR is a brand-name drug not yet available in generic form.
Standard dosing guidelines regarding the use of Quillivant XR for ADHD in children 6 years and older include the following:
The starting dose is 20 mg once daily in the morning.
The healthcare provider may gradually increase the dose to an effective dose, up to a maximum of 60 mg per day if necessary.
Quillivant XR comes in a powder form, and the pharmacist will add water to create a suspension.
Before measuring the dose with the enclosed measuring device, shake the bottle well for at least 10 seconds.
Jornay PM
Jornay PM is FDA-approved to treat ADHD and is given as an orally administered ER capsule.
Jornay PM is a brand-name drug not currently available in generic form.
Standard dosing guidelines regarding the use of Jornay PM for ADHD in children 6 years and older include the following:
The starting dose is 20 mg once daily in the evening, between 6:30 and 9:30 p.m. The healthcare provider will guide you on the best time to take it based on how it works the next day.
Jornay PM should always be taken in the evening.
The healthcare provider may gradually increase the dose, if necessary, to an effective dose, up to 100 mg per day.
You can take Jornay PM with or without food, but you should take it the same way each time.
Swallow the capsule whole; do not chew or crush. Or, you can open the capsule, sprinkle the contents onto applesauce, and consume immediately.
Side Effects and Safety
Methylphenidate stimulants have the same black box warnings as amphetamine stimulants.
And, like amphetamine stimulants, they carry the potential for mild and severe side effects.
As mentioned above, if you or a loved one develops side effects that fail to dissipate or worsen over time, contact your healthcare provider for guidance on potential next steps.
Sometimes, the prescribing provider may recommend you stop taking the medication.
Common Side Effects
Common side effects associated with the use of methylphenidate stimulants include but are not limited to:
Appetite loss
Weight loss
Anxiety
Stomach problems such as nausea, vomiting, indigestion, and stomach pain
Dizziness
Dry mouth
Increased heart rate
Increased blood pressure
Heart palpitations
Excess sweating
Trouble sleeping
Headache
Severe Side Effects
In addition to the black box warning mentioned above, serious side effects associated with the use of methylphenidate stimulants can include, but are not limited to, the following:
Anaphylaxis
Sudden death (in people who have severe heart disease)
Increased heart rate
Increased blood pressure
Manic episodes
Issues with blood circulation
Seizures
Growth suppression in children
Non-Stimulant Treatment Options for ADHD
In addition to stimulants, there are several non-stimulant drugs available that can be used to treat ADHD.
A non-stimulant medication may take longer to start working than a stimulant, but it can still improve ADHD symptoms.
A non-stimulant drug may be a better option for someone who has side effects from stimulant drugs or who has seen no improvement in symptoms from a stimulant drug.
In some cases, a non-stimulant may be prescribed along with a stimulant for increased effectiveness.
Examples of notable non-stimulant medications are discussed below.
Strattera
Strattera contains the active ingredient atomoxetine. It is FDA-approved to treat ADHD in adults and children 6 years and older. It is given as an orally administered IR capsule.
Common side effects associated with the use of Strattera include:
Stomach problems like nausea, vomiting, stomach pain, and constipation
Appetite loss
Dry mouth
Dizziness
Kapvay
Kapvay contains an ER formulation of clonidine. It is FDA-approved to treat ADHD alone or in combination with a stimulant medication.
It can be used in children and adolescents 6-17 years old. It is given as an orally administered ER tablet.
Common side effects associated with the use of Kapvay include:
Lethargy
Irritability
Trouble sleeping
Constipation
Dry mouth
Appetite loss
Dizziness
Intuniv
Intuniv contains an ER formulation of guanfacine. It is FDA-approved to treat ADHD alone or in combination with a stimulant medication.
Intuniv can be used in children and adolescents ages 6 to 17. It is given as an oral ER tablet.
Common side effects associated with the use of Intuniv include:
Lethargy
Stomach problems like nausea, vomiting, and stomach pain
Trouble sleeping
Dizziness
Qelbree
Qelbree contains an ER formulation of viloxazine.
It is FDA-approved to treat ADHD in adults and children 6 years and older. It is given as an orally administered ER capsule.
Common side effects associated with the use of Qelbree include:
Lethargy
Appetite loss
Nausea and vomiting
Trouble sleeping
Irritability
Headache
Dry mouth
Constipation
Summary
ADHD is a common condition among children, as well as adults. Treatment involves a combination of medication, therapy, and other interventions.
Some of the common medications prescribed include amphetamine stimulants, such as Adderall, or methylphenidate stimulants, such as Ritalin or Focalin.
What works for one child may not work for another, but many options are available.
Working with your healthcare provider, you can help find the best prescription option for your child.
Frequently Asked Questions
How can I safely store orally administered ADHD medications?
These medications should be stored at room temperature (68-77 degrees F), away from direct light, heat, and moisture.
Do not store medication in a bathroom. Keep ADHD medication and all other medications out of sight and out of reach of children and pets. Keep the bottle tightly closed when not in use.
Stimulants have a high risk of abuse and misuse. Because of this, if your child takes a stimulant, you should store it where no one else can get to it, preferably locked, if possible.
Keep track of the pills so you know if any are missing.
Are similar drugs used to treat ADHD in adults?
Yes, adults take many of the same medications used in children for ADHD.
However, dosing may vary according to age.
Also, some side effects vary depending on the individual's age.
Can pregnant or breastfeeding people take stimulant medications?
Stimulants have not been studied in pregnant individuals, so not much is known about their safety. Talk to your healthcare provider if you are pregnant or planning to become pregnant.
You can also consider other nondrug methods to treat ADHD symptoms during pregnancy, such as therapy and coaching.
Read the original article on Verywell Health.
