MEDICATIONS
Over the years medication has proven to be a safe and effective means of managing ADHD symptoms. The stimulant medications such as Concerta, Meditate CD, and Ritalin LA are all methylphenidate products that have been safely used for over 70 years. Daytrana (a patch) and Quillavant (a liquid) are also methylphenidate products. Focalin XR is a dexmethylphenidate product. While also stimulants, Adderall XR and Vyvanse are a mixture of amphetamine salts and exhibit a different neurological action than methylphenidate products. Because of this, sometimes Adderall or Vyvanse work when a methylphenidate product does not. Non-stimulant medications including Strattera (atomoxitine), Intuniv and Kapvay are also available.
Research has shown that the right stimulant medication, at the right dose, achieves significant benefit about 90% of the time. Our experience is that about 10% of individuals on the optimal medication and optimal dose of medication achieve a benefit that relieves most core ADHD symptoms (Inattention, Hyperactivity and/or Impulsivity). We note that about 10% either have no benefit or experience strong enough side effects that they are unable to continue with the medication. The 80% in the middle, experience a range of benefit from mild to very significant. The symptoms that remain for this group of individuals (the “leftovers”) are often managed with the other non medication based treatment interventions. **Please note - medication commonly improves CORE ADHD symptoms only. Executive Function symptoms such as Working Memory, Initiate and Plan/Organize are typically unaffected by medications.
The non-stimulants, Strattera, Intuniv and Kapvay can achieve benefit equivalent to that of the stimulants; however, this benefit is achieved about 40% of the time.
Dosing
Getting the optimal dose, for maximum benefit, is an important goal in treating ADHD with medication. Research studies have clearly shown that careful initial dosing with periodic, precise medication adjustments (titration) can maximize the benefits of ADHD medication. The initial dosing of stimulant medication is characterized by the statement “start low, go slow”. Start with a low initial dose to minimize side effects and because some individuals respond better to a low dose of the medication. Titrate the dose up slowly with follow-up testing to measure its effectiveness. By utilizing follow-up testing you will have the best possible chance to recognize when the medication reaches maximum effectiveness.
Strattera has a weight based dosing schedule. The dose is determined by the individual’s weight and minimal adjustments can be made from this dose schedule. The starting dose for Intuniv is 1.0 mg. and 0.1 mg. for Kapvay.
Side-Effects
The most common side effects of the stimulant medications are appetite suppression and difficulty falling asleep. If these side effects are experienced there are various “tricks” that can be utilized to minimize their impact. Other, less common side effects include, agitation (especially as the medication is wearing off), stomach ache and feeling emotionally flat. If significantly distressful side effects occur the medication should be discontinued as typically these side effects will not diminish over time.
The most common side effects of the non-stimulant, Strattera, are nausea and afternoon sleepiness. As with the stimulants sometimes adjustments can be made to minimize any side effects that do occur.
The Final Decision
In general, we suggest that medication is necessary for individuals diagnosed with severe ADHD. We suggest that medication should be seriously considered for individuals diagnosed with moderate ADHD. We feel that individuals diagnosed with mild ADHD have the option of taking medication but often times the alternative treatment interventions have a sufficient impact to preclude the need for medication.
The final decision to use or not use ADHD medication rests in the hands of the family. For individuals with moderate or severe ADHD we encourage families to carefully consider the "side effects" of having untreated ADHD year after year. Since ADHD affects many facets of an individual’s life including behavior, academics, socialization, self-esteem, and emotions, and since untreated ADHD can compound these issues over the years, the benefits of medication should not be overlooked.
. Primary ADHD Medications
Stimulants:
methylphenidate
Concerta 18 mg start dose
Ritalin LA 5 mg start dose
Metadate CD 5 mg start dose
Daytrana (Patch) 5 mg start dose
Quillivant XR (Liquid) 20 mg start dose
dexmethylphenidate
Focalin XR 5 mg start dose
amphetamine salts
Adderall XR 5 mg start dose
Vyvanse 20 mg start dose
Non Stimulants:
Strattera Weight based start dose
Intuniv 1 mg start dose
Kapvay 0.1 mg start dose
*Suggest starting with a methylphenidate product due to slightly lower incidence of side effects.
**Research indicates advisability of starting at lowest dose and titrating upward every 7–10 days until benefit or side effect is realized. If benefit is found, continuing to carefully titrate using standardized rating scales for precise feedback is recommended (can be completed in this office if desired). In general, inattentive symptoms tend to respond better to lower doses, while hyperactive-impulsive symptoms tend to respond better to higher doses.
