The biggest problem with these medications was their lack of flexibility. In their original forms, the stimulants required repeated dosing during the day and didn’t provide smooth, continuous effects. But the range of options has expanded over the past five years. Methylphenidate and the amphetamines now come in various short- and long-acting forms (chart). A particular medicine may work well for one child, but not so well for another. For kids who don’t respond well to stimulants, or who are likely to abuse them, a recently approved medicine called Strattera offers a non-stimulant option for managing ADHD. This medicine must be taken daily–not just as needed–and should be swallowed whole, not crushed. Like an antidepressant, it can take several weeks to produce optimal effects. Because it is so new, the jury is out on its long-term safety and efficacy.
If your child struggles with ADHD, how can you find the best medicine? We start by asking the following questions:
How many hours of relief are needed? Some medications last three to four hours, others eight to 12 hours, and the newest medication lasts all day. Most ADHD patients benefit from medication that covers all the waking hours, not just the school hours, and many continue their treatment on weekends as well as weekdays.
Can this child swallow a pill? Several preparations can be crushed or opened and sprinkled onto food, while others must be swallowed whole.
Are the benefits optimal and the side effects tolerable? Most children will experience substantial improvement in their ADHD symptoms with minimal side effects. If not, maybe the dose is wrong or another medicine would work better. Finding the best choice can take some trial and error, but medication options for treating ADHD have never been better.
CORRECTION
In a recent list of medications for ADHD (“Tailoring the Treatment,” Sept. 22), we noted that some can be “crushed or split,” while others should be taken whole. Metadate CD, Ritalin LA and Adderall XR can be opened and sprinkled into food, but the contents of these capsules should not be crushed. Ritalin, Dexedrine and Adderall tablets can all be safely crushed, but Dexedrine Spansules should not be crushed or chewed.
