Tag: adhd

Choosing the Best ADHD Medication for Your Child

There are a lot of options when it comes to treating kids with ADHD.

In addition to behavioral therapy, there are a number of different stimulant and non-stimulant medications.

How do you choose the best ADHD medication for your child?

Is there a best ADHD medication for your child?

What Types of ADHD Medication Are Available?

When DSM-II was published, in 1968, Ritalin had already been studied and was being used to treat hyperkinetic children with minimal brain dysfunction syndrome.
When DSM-II was published, in 1968, Ritalin and Adderall had already been studied and were being used to treat hyperkinetic children with minimal brain dysfunction syndrome.

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

  • Stimulants – Adderall/Amphetamine vs Ritalin based
  • Non-Stimulants – Intuniv (extended release guanfacine), Kapvay (extended release clonidine), Strattera

Remember, that 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.

Other off-label medications for ADHD that are also sometimes used include bupropion (Wellbutrin), tricyclic antidepressants such as desipramine (Norpramin), and imipramine (Tofranil), and modafinil (Provigil or Nuvigil).

Yes, we have come a long way from Dr. Charles Bradley’s first studies of benzedrine (racemic amphetamine) in 1937.

How to Choose ADHD Medication for Your Child

Once you start looking at medication options, the first thing to keep in mind is that there is no one single ADHD medication that is better than others for all kids.

The best ADHD medication is going to be the one that your child will take and which controls your child’s symptoms without side effects (or with minimal side effects) for as long as you need it to, without costing an arm and a leg.

So, do you want an ADHD medication that comes as a chewable pill, a pill or capsule that your child can swallow, a capsule that can be opened and sprinkled on food, a dissolvable tablet (ODT), a liquid, or a patch?

How long do you want it to last? 4, 6, 8, 10, 12 hours?

Is your child going to take it every day or just on school days?

What ADHD medicines has your child already tried?

Answering those questions will help to narrow down which ADHD medicine might be best for your child.

ADHD Medications

Again, there is really no one best ADHD medicine.

“…stimulant medications are highly effective for most children in reducing core symptoms of ADHD.”

American Academy of Pediatrics ADHD Clinical Practice Guideline

And you don’t even have as many options as you think you do.

While it may seem like there are dozens of medications available to treat ADHD now, most are really just different variations of the same few active ingredients.

And if you don’t have insurance or if you have have a high deductible, you will want to know that those that aren’t yet generic (in bold) are going to be much more expensive than the others:

  • Short Acting Stimulants (4 to 6 hours) – Adderall, Evekeo, Focalin, Methylin (chewable), ProCentra (liquid), Ritalin, and Zenzedi (often taken twice a day)
  • Intermediate Acting Stimulants (6 to 8 hours) – Dexedrine, Ritalin SR, Methylin ER
  • Intermediate to Long Acting Stimulants (8 to 10 hours) – Focalin XR, Metadate CD, Metadate ER, and Ritalin LA
  • Long Acting Stimulants (10 to 12 hours) – Adderall XR, Adzenys XR-ODT, Aptensio XR, Concerta (Methylphenidate ER), Cotempla XR-ODT, Daytrana (patch), Mydayis, Quillichew ER (chewable), Quillivant XR (liquid), and Vyvanse (capsule and chewable)
  • 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.

And there isn’t one medication that targets specific symptoms better than another, so you don’t need to look for a specific medication just because your child has the inattentive type of ADHD vs another who is also hyperactive and impulsive.

Deciding Which Medication Is Best for Your Child

Which ever medicine you choose, you typically want to start at a low dose and slowly adjust the dose up or down as necessary based on how well it is working and whether or not your child is having any side effects.

“…more than 70% of children and youth with ADHD respond to one of the stimulant medications at an optimal dose when a systematic trial is used.”

American Academy of Pediatrics ADHD Clinical Practice Guideline

Keep in mind that:

  • generic, short acting Ritalin (methylphenidate) is often going to be your least expensive option
  • coupons are often available for newer medications to lower or eliminate your copay, but that doesn’t help you if you don’t have insurance, have a high deductible, or if a medication isn’t covered by your insurance
  • it often takes a few days for kids to adjust to being on an ADHD medication, so don’t judge them too quickly
  • it doesn’t take weeks or months for an ADHD medication to work, so don’t wait too long to make adjustments
  • if your child is having major side effects, don’t just switch medications, be sure to switch the active ingredient too. For example, if a low dose of Metadate CD made your child very irritable and caused trouble sleeping, then switching to Ritalin LA doesn’t make much sense, as they are both time release versions of methylphenidate. Other ADHD that contain methylphenidate as an active ingredient include , Aptensio, Concerta, Cotempla XR-ODT, Daytrana, Methylin, QuilliChew ER, and Quillivant XR.
  • many of the newest medications, including Evekeo, Zenzedi, and Mydayis, are really just different forms of Dexedrine, one of the first ADHD medicines.
  • you can open and sprinkle the contents of Adderall XR, Aptensio XR, Focalin XR, Metadate CD, Ritalin LA, and Vyvanse on applesauce if your child can’t swallow these capsules. The contents of Vyvanse is a powder and will easily dissolve in a small amount of water! These are often less expensive options than a newer chewable, liquid, or dissolvable tablets.
  • you can not open Concerta and Metadate CD or you will ruin the time release delivery system. They must be swallowed whole.
  • while there is an authorized generic for Concerta, there are some generic versions that do not have the same therapeutic effect because they do not have the same extended delivery system. Make sure you are getting an authorized Concerta generic.
  • some extended release ADHD medications simply mimic taking the medication twice a day, giving 50% of the dose in the morning and another 50% later in the day, like Adderall XR, Focalin XR, Metadate ER, Ritalin LA, and Vyvanse
  • other extended release ADHD medications have different time release schedules. For example, Concerta gives 22% of the dose immediately and then slowly time releases the rest throughout the day. Similarly, Metadate CD releases 30% of the dose immediately and the rest later. Aptensio XR uses a 40/60 delivery system. And Daytrana, the patch, slowly time releases the dose throughout the day.
  • although some people start the day with an intermediate or long acting medication to get their child through school and then a short acting medication after school, before doing this, consider increasing the dose of the intermediate or long acting medication to see if it will last longer
  • non-stimulants are pills that must be swallowed and they typically must be given to your child every day for them to work properly
  • genetic tests to try and see which medications will work best for your child have not been tested on kids
  • even if you are only going to be giving your child medication on school days, be sure to give it every single day at first, even weekends, so that you can more easily see what side effects it might be causing. Otherwise, since it could wear off by the time you see your child after school, you might miss uncommon side effects, like if it made him too calm or more irritable.
  • being able to concentrate and do your work and not getting distracted and talking with your friends all of the time is not a side effect – it is the desirable effect.

Most importantly, know that you can take out a lot of what might seem like guess work if you have a good understanding of how these medications work.

What To Know About Choosing an ADHD Medication

For the great majority of kids with ADHD, one of the many available medications will help to control their symptoms of inattention, hyperactivity, and impulsiveness. Learn how to choose the best one for your child.

What To Know About Choosing an ADHD Medication

Understanding and Treating Teen Sleep Problems

Do your kids have to get up too early because school starts too early?
Do your kids have to get up too early because school starts too early?

Parents often ask for help getting their kids to fall sleep and then stay asleep all night.

At least they do when they are little.

Teens often have trouble sleeping too though, but parents often don’t recognize these sleep problems and might not think to ask for help. They do likely see some of the issues that can be caused by a poor night’s sleep though, which can include irritability, sadness, a poor attention span, and hyperactivity, etc.

Why Teens Don’t Sleep Well

From being over-scheduled and having to get up early for school to staying up late on a screen, there are many reasons why your teen might not be sleeping well.

There are also many different types of sleep problems.

To understand what is causing your child’s sleep problems, ask yourself these questions and share the answers with your pediatrician:

  • Does your teen sleep at least 8 1/2 to 9 1/2 hours each night?
  • Does your teen have trouble falling asleep or does he just wake up a lot in the middle of the night? Or does your teen seem to sleep enough, but is still always tired?
  • Does your teen snore loudly at night – a sign of obstructive sleep apnea?
  • Is your teen taking any medications that could cause insomnia, such as for ADHD (stimulant) or allergies (decongestant)?
  • Does your teen have poorly controlled allergies, asthma (late night coughing), eczema (frequent itching keeping him awake), or reflux?
  • Is your teen drinking any caffeine in the afternoon or evening?
  • Do you think that your teen is depressed or has anxiety, either of which could cause problems sleeping?
  • Have you noticed any symptoms of restless leg syndrome, including a strong urge to move his legs when he is sitting or lying down?
  • Does your teen have too much homework and is staying up late trying to get it all done?
  • What does your teen do just before going to sleep?
  • Does your teen fall asleep easier when he goes to bed much later than his typical bedtime or does he still have trouble falling asleep?
  • Are your teen’s sleep problems new?

And perhaps most importantly, what is your teen’s daily sleep schedule like? What time does he go to sleep and wake up, including weekends, and does he typically take a nap?

Treatments for Teen Sleep Problems

In addition to treating any underlining medical issues that might be causing your teen to have trouble sleeping, it will likely help if your teen learns about sleep hygiene and:

  • goes to bed and wakes up at about the same time each day, instead of trying to catch up on “lost sleep” on the weekends
  • keeps his room bright in the morning (let in the sunshine) and dark at night
  • avoids taking naps, or at least naps that are longer than about 30 to 45 minutes
  • avoids caffeine
  • is physically active for at least one hour each day
  • doesn’t eat a lot just before going to bed
  • turns off all screens (phone, TV, computer, video games, etc.) about 30 minutes before going to sleep
  • doesn’t get in bed until he is actually ready to go to sleep, which means not watching TV, reading, or doing anything else on his bed
  • gets out of bed if he doesn’t fall asleep after 10 to 15 minutes and reads a few pages of a book, before trying to go to sleep again

Did that work?

If you teen is still having sleep problems, encourage them to try some basic relaxation techniques, such as progressive muscle relaxation, guided imagery, and deep breathing or abdominal breathing. You do them at bedtime and again if you wake up in the middle of the night.

I especially like the idea of guided imagery for teens, as they can focus on something they like to do, whether it is building a sandcastle on the beach, or going horseback riding, surfing, hiking, or playing baseball, etc. They should focus on the details of the story they make up, coming back to it if their mind wanders, and hopefully they fall asleep as they get caught up in it.

With the deep breathing technique, they slowly breath in through their nose and out through their mouth. They can hold their breath for a few seconds or breath into their abdomen too (abdominal breathing).

Progressive muscle relaxation is another technique that might help your child relax at bedtime. They simply tense and then relax each muscle group of their body, one at a time, starting with their toes and working their way up. If they make it up to their forehead and aren’t asleep, then they should work their way down, perhaps doing 3 to 5 repetitions for each muscle group,  or try another technique.

And be sure to talk to your pediatrician if your teen continues to struggle with sleep problems.

What To Know About Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

For More Information on Teen Sleep Problems

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.

Treating Hard to Control ADHD

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