• Methylphenidate as Active
  Includes the following stimulant branded medicines:
  • Concerta XL
  • Equasym
  • Equasym XL
  • Medikinet
  • Medikinet XL
  • Ritalin
• Dexamfetamine as Active
  Includes only stimulant medicines and currently, there is only one medicine in this category called Dexedrine.
• Atomoxetine as Active (since May 2004)
  Includes only non-stimulant medicines and currently, there is only one medicine in this category called Strattera.

Methylphenidate and dexamfetamine, as ‘stimulant medicines’, are useful in treating ADHD in children. This has an evident history of approximately 30 years.

Atomoxetine, being a non-stimulant medication, is useful in treating ADHD in children who are six or above and adolescents. Sometimes, it is permitted to be used even when adolescents have entered into their adulthood.

What These Medicines Do?

Even today, the experts have not fully comprehended about how the medicines function to improve the problematic behavior. Further, this also is true that these medicines are not suitable for everyone and that they do not cure ADHD.

However, to gain a general idea on how these medicines works, they function by acting on a few natural chemicals present in the critical part of the body, i.e. the brain. They actually affect two chemicals namely, noradrenaline and dopamine that are present in the different parts of the brain. These chemicals have a say in controlling behavior and concentration.

Therefore, these medicines do control the symptoms of inattentiveness and impulsivity. This means that one can expect better concentration and calm and less hyperactive behavior, which directly indicates:

• Better listening power
• Good understanding power
• Improved attention span
• Improved learning ability
• Clear thinking before acting
• Still sitting
• No fidgeting
• No boredom and disruptiveness
• Interest in studying and making friends
• Boosted self-confidence
• Improved behavior overall

To obtain the results, children do need encouragement along with the medications.

When and How Long Do I Take Medicines?

The psychiatrist or a pediatrician specializing in ADHD would prescribe the medicines once

• Diagnosis having ADHD is done.
• Discussion with the parents and child is done.
• Child’s age is suitable for the medicine.

Initially, the child psychiatrists and specialists prescribe. Later on, your GP might prescribe and monitor the child.

The duration for which the prescribed medicines need to be taken is completely based on the individual. The duration is based on the improvement as listed below.

• No Improvement
  If there is no improvement shown even after raising the dose to the highest level, discuss with your doctor regarding the continuation of the medicine. It is recommended to stop the intake of such a medicine.
• Improvement
  If there is some kind of improvement, the doctor is more likely to ask to continue for a year at its minimum. After a year, the doctor might ask to stop the medicines to see the improvement in the child without the medicines. Such a start and stop can be done every year, but doctor’s supervision is mandatory.

To be concluded, some children might take medicines for a few years, some stop the intake until puberty, while others take even in adolescence.

What are the Side Effects?

Every medicine has its own side effects and even ADHD medicines are not an exception to this fact. To add to this, one more fact is that not all patients will experience the side effects of a prescribed medicine. So, one cannot say whether a person will suffer from any side effect of a medicine.

On way to tackle side effects, if they become a problem is to decrease the medicine dose. It might also happen that side effects decrease after continuing the treatment for many weeks. Listed below are the side effects associated with the ADHD medicines.

• Stimulant Medicines (Methylphenidate and Dexafetamine)
  Decrease in the appetite and difficulty in sleeping
• Non-stimulant Medicine
  Decrease in the appetite and stomachache

Because of the above side effects, the doctor will monitor the following aspects regularly:

• Weight and height that might be affected due to change in the appetite
• Heart rate and blood pressure

Methylphenidate

There are six brands and one unbranded form of methylphenidate available. The unbranded form is just known as methylphenidate.

Equasym, Medikinet, Ritalin, and Unbranded Methylphenidate

• Working
  These medicines immediately release methylphenidate within about 30 to 60 minutes after taking a dose.
• Effects Time
  Effects are felt after three to four hours of intake.
• Intake Time
  These medicines can be taken twice or thrice daily such as, in early morning (rare cases), at breakfast, and at lunchtime. However, note that the last dose should be taken before four hours of bedtime due to the side effect of sleeping difficulty.
• Dose
  The doctor might suggest taking either half or quarter part of the tablet. For each child, the dose might vary and should be revised by the doctor from time to time.
• Strength
  Except for Ritalin, all the other medicines are available in 5 mg, 10 mg, and 20 mg. Ritalin is available in 10 mg.

Concerta XL

• Working
  It is an extended form whose outer layer dissolves instantly. The remaining part of the tablet is released slowly throughout the day. The tablet does not get fully dissolved in the digestive system, so its shell can be noticed in the stools; for which there is nothing to worry.
• Effects Time
  Effects last for 12 hours. This is equivalent to the three doses of Equasym, Medikinet, Ritalin, and unbranded Methylphenidate.
• Intake Time
  This medicine can be given once in the morning without any need for further dose.
• Intake Method
  It is mandatory to swallow Concerta XL with water or any liquid, as it cannot be broken or chewed.
• Strength
  It is available in 18 mg, 27 mg, and 36 mg.

Equasym XL

• Working
  It is an extended form that discharges 30 percent of methylphenidate instantly, while the remaining 70 percent is discharged slowly throughout the afternoon.
• Effects Time
  Effects might last until the early evening in certain children. Because the way it functions, the capsule once given in the morning, need not be given in the school. This is equivalent to the morning and lunchtime doses of Ritalin, Equasym, or unbranded methylphenidate.
• Intake Time
  It usually can be taken in the morning once. However, if there is some problem in the evening after the effect of the morning dose is over, the doctor might suggest a small dose of instant release methylphenidate.
• Intake Method
  This medicine can be swallowed with water or some liquid. Not only this, you can open the medicine and sprinkle its contents on food that needs to be taken immediately. However, one must not chew or crush it.
• Strength
  It is available in 10 mg, 20 mg, and 30 mg.

Medikinet XL

• Working
  It is an extended form that discharges 50 percent of methylphenidate instantly, while the remaining 50 percent is discharged slowly throughout the afternoon.
• Effects Time
  Effects might last until the early evening in certain children. Because the way it functions, the capsule once given in the morning, need not be given in the school. This is equivalent to the morning and lunchtime doses of Ritalin, Medikinet, Equasym, or unbranded methylphenidate.
• Intake Time
  It usually can be taken in the morning once. However, if there is some problem in the evening after the effect of the morning dose is over, the doctor might suggest a small dose of instant release methylphenidate.
• Intake Method
  This medicine can be swallowed with water or some liquid. Not only this, you can open the medicine and sprinkle its contents on food that needs to be taken immediately. However, one must not chew or crush it.
• Strength
  It is available in 10 mg, 20 mg, 30 mg, and 40 mg.

Dexamfetamine

• Working
  It starts to function within about 30 to 60 minutes after taking a dose.
• Effects Time
  Effects lasts until three to four hours of intake.
• Intake Time
  These medicines can be taken twice or thrice daily such as, in the morning, at lunchtime, and in early evening (around 4 p.m.).
• Dose
  The doctor might suggest cutting the tablet. For each child, the dose might vary and should be revised by the doctor from time to time.
• Strength
  It is available in 5 mg.

Atomoxetine

• Effects Time
  This medicine is fully effective only after four weeks. However, the child starts getting relief in the first week itself after the treatment is started.
• Intake Time
  It can be taken in the morning daily.
• Dose
  The doctor suggests a low dose for a week, which is then increased up to the desired level. However, due to side effects, the doctor can ask you to divide the current dose, one in the morning and the other late in the afternoon.
• Intake Method
  It is mandatory to swallow Strattera with water or any liquid, as it cannot be broken, opened, or chewed.
• Strength
  It is available in 10 mg, 18 mg, 25 mg, 40 mg, and 60 mg.

The Dos and Don’ts

The physical composition of each human is different and so is its response to different medicines. This means that if a specific medicine is prescribed for a child having ADHD, it would be wrong to think that the same medicine will be appropriate for other child having ADHD. Not only this, but also your age of the child and other situations matters in deciding the suitability of any medicine. In a few cases of ADHD, it is found that instead of medications, behavioral and other therapies give good results. Therefore, there are certain dos and don’ts that need to be kept in mind for this medication.

The Dos

Use dexamfetamine carefully when a single or a few of the following has taken place.

• A little increase in blood pressure
• A past of psychotic illness
• Bipolar affective disorder
• Anorexia
• Epilepsy
• Kidney problems
• A family background of involuntary muscle spasms

The Don’ts

Dexamfetamine should be avoided for children who:

• Are under three years of age
• Have a past of alcohol or drug abuse
• Have diseases related to the heart and blood vessels
• Have compositional heart abnormalities
• Have moderate to high blood pressure
• Have hyperthyroidism
• Have glaucoma (related to eyes)
• Have Tourette’s syndrome
• Have involuntary muscle spasms (twitches or tics)
• Have porphyria (genetic blood disorder)
• Have allergy to any items with which the tablets are made up of

Dexamfetamine with Other Medications

Before the intake of this medicine, do not forget to inform your doctor about the other medicines that you must be giving to your child. These medications involve the ones that are used without any prescription, such as the herbal ones. In addition to this, you also need to consult your doctor or pharmacist before taking a new medicine if you have started the medication of dexamfetamine. Medicines that should not be taken with dexamfetamine are:

• Monoamine Oxidase Inhibitors (MAOIs)
  These are antidepressants that are taken for treating depression and include phenelzine, tranylcypromine, isocarboxacid, and moclobemide that when given with dexamfetamine inflicts conditions on the body. If dexamfetamine needs to be given, it should be given only after 14 days from the last consumption of these antidepressants.
• Tricyclic Antidepressants
  Includes imipramine.
• Antipsychotics
  Haloperidol and chlorpromazine (a phenothiazine) should not be avoided.
• Cough and Cold Medications
  Verify with the pharmacist before taking such medicines with dexamfetamine, as they might contain certain ingredients that are not to be mixed with dexamfetamine.
• Lithium and Phenothiazines
  These might result in decreased effect of dexamfetamine.

Side Effects of Dexamfetamine

Like all medicines, dexamfetamine too has side effects. However, it is not mandatory that all people taking it will experience these side effects. There are many side effects of dexamfetamine. Listed are the most common side effects of dexamfetamine.

• Stomachache
• Reduced appetite
• Irritation
• Headache
• Restlessness
• Dry mouth
• Widening of the pupils
• Dizziness
• Nausea
• Tremor
• Nervousness
• Changes in blood pressure
• Increase in heart rate
• Difficulty in sleeping
• Nightmares
• Sweating
• Happiness
• Muscle twitches

This is not all. To be aware of all the possible side effects, you are required to go through the patient information leaflet that is obtained along with the medicine from a medical store. If you observe any of these side effects, consult your doctor.

Initially, due to atomoxetine, your child might lose weight temporarily, as this medicine results in reduced appetite. Therefore, as a precautionary measure, your child’s height and weight needs to be monitored. However, if in the long run, the growth is improper or the weight is not satisfactory, it is advisable to stop the intake of this medicine to cope up with growth problems.

It is a must to avoid alcohol while taking this medicine.

Regular monitoring of children taking dexamfetamine is necessary due to such critical side effects. It is recommended to the stop the intake of this medicine slowly after consulting to your doctor, as a sudden stop of intake can result in too much tiredness and depression.

ADHD Causes

Biological and environmental factors are the root causes of ADHD. Out of these, the biological factors are:

• Temperament of the child that is responsible for attitude and personality.
• Genetic conditions wherein if one twin has ADHD, the other also has 80-90 percent chance to have it. According to a recent research, this disorder is more likely to be inherited from males such as fathers and grandfathers.
• Damaged parts of the brain because of shock or pre-birth problems. These regions that are responsible for the development of ADHD are prone to hypoxic damage at the time of birth. Such a damage is caused by insufficient oxygen being supplied to the brain, while on the other hand; the blood flow is reduced.

Listed are the environmental factors that might lead to ADHD.

• Stress due to family conditions
• Educational difficulties

ADHD Symptoms

Here are the major symptoms of ADHD that are usually not mild so that they can be considered under the ADHD disorder.

• Difficulties in Attention
• Hyperactivity
• Impulsivity

Other symptoms can be any or combination of the list below.

• Grand mal or petit mal epileptic seizures, leading to drowsiness, attention impairment, and abnormal behaviour and perceptions
• Difficulty in hearing like deafness or glue ear, making it tough for a child to follow the instructions and forcing him/her to appear as daydreaming (inattentive)
• Reading problems that make it tough to complete jobs or follow the orders
• Obsessive disorder, making people commit odd rituals that preoccupy their thoughts and divert their attention
• Tourette’s syndrome that includes frequent and unintentional body jerks, abrupt outbreak of noise, or swearing
• Autism and Asperger’s syndrome that give rise to problems in understanding and language
• Extended duration of improper sleep that leads to significant low concentration

Difficulties in Attention

Here is the list of symptoms related difficulties in attention, out of which minimum six must be exhibited for at least six months to a remarkable extent keeping in mind the child’s age and aptitude level.

• Falls short of paying and sustaining close attention at work or play
• Makes careless mistakes while playing or working
• Fails to complete the tasks
• Appears like not listening to what is being told
• Fails to follow the instructions
• Fails to finish the homework or daily tasks
• Fails to organize tasks and activities
• Avoids activities wherein continuous mental effort is needed
• Forgets basic things that are mandatory for completing an assigned task or activity, such as pencil, rubber, notebook, or item related to play.
• Is easily distracted
• Fails to remember while performing daily activities

Hyperactivity

Here is the list of symptoms related hyperactivity, out of which minimum three must be exhibited for at least six months to a remarkable extent keeping in mind the child’s age and aptitude level.

• Runs around
• Excessively mounts over things.
• Feels restlessness (normally in adolescents or adults)
• Excessively noisy while playing
• Finds it tough to involve silent activities during free time
• Gets up from the seat in the classroom or in other situations wherein being seated is predicted
• Fiddles with hands or feet
• Fidgets on the seat

Impulsivity

Here is the list of symptoms related impulsivity, out of which minimum one must be exhibited for at least six months to a remarkable extent keeping in mind the child’s age and aptitude level.

• Utters answers without waiting for the questions to be completed
• Fails to stay in queues
• Fails to wait for the turn in games or group plays
• Interrupt others, such as intruding into others’ conversations or games
• Speaks too much without proper response

Difficulties Accompanying ADHD

There are many other difficulties along with which ADHD occurs often and whose union leads to problematic behaviors. These include revealing bad temper, sleep disorders, and clumsiness. Listed below are the other behavioral problems that take place with ADHD.

• Confrontational defiant behaviour, wherein the child exhibits anger, argues, refuses to obey their elders, and intentionally irritates others. This is observed in around 60 percent of the victims.
• Conduct disorders (destructive and deceitful behavior), wherein a child lies, breaks rules, or steals. This is observed in around 25 percent of the victims.
• Dyslexia, wherein a child finds it difficult to learn, calculate, and write. This is observed in around 25-30 percent of the victims.
• Severe depression, which is observed in 33 percent of the victims.
• Anxiety disorders, which is observed in 30 percent of the victims.

Diagnosis

A medical diagnosis needs to be done for ADHS. A doctor who is a child or adolescent psychiatrist, paediatrician, paediatric neurologist, or GP performs the diagnosis. Contribution of other professionals like psychologists, speech therapists, teachers, and health visitors is of a great benefit for the examination of a child with the probability of having ADHD. The diagnosis is performed by gathering different information, as there is no single test for this.
Listed below are the types of information gathered during the diagnosis phase.

• History of symptoms
• Medical history
• Past psychiatric history
• Educational history
• Child’s temperament and personality
• Family history
• Social background

History of Symptoms

This kind of information involves being aware of the exact nature of the difficulties being faced, the time when they were initially observed, the conditions due to which they occur, and the causes that relieve them.

Medical History

One of the risk factors that matters here is the mother’s health. Information regarding whether the mother’s health not good or was too young during the time of delivery, does she have the habit of smoking or drinking, and had the mother undergone extended or complicated labor is collected.

The occurrence of fragile-X syndrome, fetal alcohol syndrome, G6PD deficiency, phenylketonuria, and generalised resistance to thyroid hormone in the past or present are also taken into account. Not only this, but also accidents, operations, chronic disorders such as epilepsy, asthma, and heart, liver, and kidney disorders are considered.

Any medication been taken by the child or is currently taking is of great relevance.

Past Psychiatric History

Investigation is done to identify any mental problem that the child might have. This can aid in ruling out the symptoms of depression or anxiety.

Educational History

Enquiry is done regarding their learning ability and difficulties and how they behave with their peer groups and teachers.

Evaluation of the Child’s Temperament and Personality

The child’s temperament and personality along with that of other family members is enquired. Further, the type of relationships within the family may also be examined. Discussion on how parents manage the child’s behaviour is done here. This will actually make parents feel that this is an unexpected interference. However, the assessor would not pin point anyone. A tip for parents here is not to feel that they are cause of ADHD in their children.

Family History

The parents’ mental and physical health along with those of the family members is of utmost relevance.

Social Background

This includes collecting information regarding housing area, poverty, and social support that have an impact on the child’s behaviour on a large scale.

ADHD Treatment

A guidance or advice from a psychologist along with the diagnosis results would be of great help to treat ADHD. It’s a difficult task to live with a child having ADHD. Therefore, both parents and teachers must try to deal with the child’s problematic behavior. Some ways of management are:

• Create a daily schedule for the child.
• Be clear, specific, and reasonable in your instructions. For instance, instead of telling the child to ‘behave’, say ‘play Snakes and Ladders quietly for 30 minutes’.
• Be steady in the handling the child
• Avoid troublesome or disturbing elements in daily routine. For example, switch of the radio during their homework time.
• Plan for such programmes that are focused at increasing the span of the child’s concentration.
• Speak face-to-face with the child and avoid talking with other children simultaneously.
• Provide rewards (stickers, toys, money, etc.) consistently to strengthen proper behaviour.
• Allow sanctions (loss of rewards, no T.V. etc.) for unpredicted behaviour.
• Opt for psychological treatments such as cognitive therapy and individual psychotherapy.
• Provide social skills training.

Prescribed Medicines

According to a U.S. research, medication is the ideal choice for ADHD. The common and effective medicines prescribed for ADHD are amphetamine-like stimulants, methylphenidate (Ritalin) and dexamfetamine (Dexedrine).

Ritalin aids in decreasing the intensity of hyperactivity and impulsiveness and in increasing the child’s attention. The positive signs in your child due to Ritalin are less aggressiveness, compliance with instructions, better memory. Many parents have informed that Ritalin has greatly improved their child’s behaviour. However, on the other hand, Ritalin has critical negative effects on the cardiovascular and nervous systems. Therefore, it is recommended only for children of 6 years and above and until a month if there is not improvement.

Probable Outcome

Nearly half of those affected by ADHD start living a normal life at an early stage of adulthood. However, a considerable number of children will face problems even in their adulthood. These problems might be depression, related to attention, and antisocial behavior.