Treating Hard to Control ADHD

ADHD is often much harder to treat than many people imagine.

It isn’t always just a matter of writing a script for Adderall or Ritalin and then have kids who had been failing suddenly jump to the ‘A’ Honor Roll.

ADHD Treatments

Whether your child’s ADHD symptoms include problems with inattention, hyperactivity and impulsivity, or both, the treatments are the same:

Stimulants – Adderall vs Ritalin based
Non-Stimulants – Intuniv (extended release guanfacine), Kapvay (extended release clonidine), Strattera
Behavior Management Therapy

Although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

ADHD Medications

Surprisingly, there is really no one best ADHD medicine. Those that aren’t yet generic (in bold) are going to be much more expensive than the others.

Short Acting Stimulants – Adderall, Focalin, Methylin (chewable), ProCentra (liquid), Ritalin
Intermediate Acting Stimulants – Dexedrine, Ritalin SR, Methylin ER
Long Acting Stimulants – Adderall XR, Adzenys XR-ODT, Concerta (Methylphenidate ER), Daytrana (patch), Focalin XR, Metadate CD, Metadate ER, Quillichew ER (chewable), Quillivant XR (liquid), Ritalin LA, Vyvanse
Non-Stimulants – Intuniv, Kapvay, Strattera

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

What do you do when your child’s ADHD treatments aren’t working?

While it is important to “initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity,” it is important to remember that not all kids with academic or behavioral problems have ADHD.

So the first thing you should do is confirm that your child really does have ADHD. Is it possible that your child was misdiagnosed and doesn’t have ADHD at all? Or could your child have ADHD and another co-morbid condition, including “emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions.”

Next, ask yourself these questions and discuss the answers with your pediatrician:

Is your child taking his medicine?
Does your child need behavior management therapy?
Are you not getting your child’s ADHD medicine because of how expensive it is? Ask your pediatrician about a lower cost generic ADHD medicine.
Has there been a sudden worsening of previously well controlled ADHD, which might indicate a problem with bullying, social changes at home, abuse, or depression, etc.?
Are you relying on restrictive diets or other alternative treatments for ADHD that have been proven to not usually work?
Does your child need a different dosage of his current stimulant, either a higher or lower dose?
Is your child’s medication wearing off too soon?
Does your child’s medication take too long to work?
Does your child need to switch to a different stimulant or to a stimulant with a different delivery method?
Does your child need to switch from a long-acting stimulant to a short-acting stimulant?
Does your child need to switch to a non-stimulant, keeping in mind that these are often used in combination with a stimulant and not by themselves.
Do you need to adjust your expectations for what kind of control you can get from even maximal treatment?
Does your pre-teen or teen with ADHD not want to take his medication anymore?
Are side effects keeping your child from taking his ADHD medicine everyday?
Does your child need 504 plan accommodations at school and/or an IEP?

And perhaps most importantly, what is making your child’s ADHD hard to control? Is he just still having some ADHD symptoms or are those lingering ADHD symptoms causing an impairment? If they aren’t causing an impairment, such as poor grades, problems with friends, or getting in trouble at school, etc., then your child’s ADHD may be under better control than you think.

What To Know About Treating Hard to Control ADHD

ADHD can sometimes be hard to control and require more than just a quick prescription for Ritalin or Adderall, including adding behavior therapy, careful monitoring, and special accommodations at school.

More Information About Treating Hard to Control ADHD

Last Updated on February 21, 2021 by Vincent Iannelli, MD

Author: Vincent Iannelli, MD

Vincent Iannelli, MD View all posts by Vincent Iannelli, MD

ADHD Treatments

ADHD Medications