ADHD Medication for Children

ADHDis a psychiatric disorder usually diagnosed duringchildhood. Children with ADHD are often hyperactive (overactive) and have difficulty paying attention and staying focused on tasks. They may interrupt other people's conversations or be impulsive and impatient. ADHD symptoms can cause problems at home and at school, and often will last into adulthood.

According to The American Psychiatric Association, 5% of children in the US have ADHD. However, studies have shown that 11% of children aged between 4 and 17 years had ADHD in 2011. Theprevalenceof ADHD is increasing, from 7.8% in 2003 to 11% in 2011. ADHD is more common in boys compared to girls (13.2% and 5.6% respectively).

Treatment options for ADHD in children include stimulant and non-stimulant medications and behavioral therapy.

Many medications are available for the treatment of ADHD in children.

• ios万博ManBetX客户端 (dextroamphetamine/amphetamine)
• Dexedrine (dextroamphetamine)
• Dextrostat (dextroamphetamine)
• ProCentra(dextroamphetamine) oral solution

• Adderall XR (dextroamphetamine/amphetamine extended-release)
• Concerta(methylphenidatelong-acting)
• Daytrana(methylphenidate patch)
• Desoxyn(methamphetaminehydrochloride)
• Focalin(dexmethylphenidate)
• Focalin XR(dexmethylphenidate extended-release)
• Metadate ER(methylphenidate extended-release)
• Metadate CD(methylphenidate extended-release)
• Methylin (methylphenidate oral solution and chewable tablets)
• Quillivant XR(methylphenidate extended release powder for oral suspension)
• Ritalin(methylphenidate)
• Ritalin SR (methylphenidate extended-release)
• Ritalin LA(methylphenidate long-acting)
• Strattera(atomoxetine)
• Vyvanse(lisdexamfetaminedimesylate)

ADHD medications are prescribed to improve attention and reducehyperactivityandimpulsivityin children. They may also be used to improve the ability to focus, work and learn. In addition, they may be used to reduce aggression, provide a calming effect and improve coping with frustration.

Stimulants (such as methylphenidate, amphetamine, dextroamphetamine) and non-stimulants listed below.

• Strattera (atomoxetine)
• Intuniv(extended releaseguanfacine)
• Kapvay(extended releaseclonidine)

Tricyclic and selectiveserotoninreuptakeinhibitors (SSRIs) may be helpful in ADHD. They can also be combined with stimulants when patients have another mood disorder, such as depression.

Selection of an ADHD medication selection depends on patient-specific factors as well asdrug side effects, interactions, and existing conditions. However, stimulant medications have been studied the most and have more evidence of use.

The National Institute of Mental Health states that no single treatment is best for all children and to consider the child's needs as well as personal andmedical history.

For preschool-aged children (4 to 5 years old): Evidence-based behavior therapy is recommended. However, medication may be added if there is no improvement. Methylphenidate is recommended over amphetamines or non-stimulants.

For school-aged children (6 to 11 years old): FDA-approved ADHD medications and/or behavior therapy are recommended. A stimulant is recommended over atomoxetine, guanfacine, and clonidine.

Consider low-dose short-acting medications for children younger than 6 years old to minimize dose-related side effects.

Long-acting medications may be used in children over 6 years, starting at a low dose and titrating for maximum efficacy while minimizing side effects. Long-acting or extended-release dosage forms may improve adherence and are less likely to be misused.

A combination of long-acting and short-acting medications may provide extra coverage when needed such as for the completion of homework after school.

Atomoxetine may be preferred for patients with a history ofsubstance abuse. Clonidine or guanfacine may be chosen if there are unacceptable side effects, major comorbidities, or a poor response to stimulants or atomoxetine.

For adolescents (12 to 18 years of age):FDA-approved ADHD medications and behavior therapy are recommended, preferably together.

• Methylin (methylphenidate oral solution)
• ProCentra (dextroamphetamine oral solution)
• Quillivant XR (methylphenidate extended release powder for oral suspension)

ADHD medication side effects in children include

• decreased appetite,
• headache,
• anxiety,
• nausea,
• dizziness,
• vomiting and abdominal pain.
• Insomnia,
• dizziness, and
• restlessness is also common.

Other side effects include weight loss,anorexia, andpruritus(itching).

Non-stimulants may causehypotension, drowsiness, sedation, and fatigue. Guanfacine and clonidine may causexerostomia(dry mouth).

There are several warnings and precautions related to the use of ADHD medications in children.

Administration of stimulants can lead to physical and psychological drug dependence. Therefore methamphetamine is contraindicated in patients with a history ofalcoholism.

• Dexmethylphenidate and methylphenidate are contraindicated in patients with anxiety since they can worsen this condition.
• Dextroamphetamine/amphetamine, dextroamphetamine, and methamphetamine are contraindicated for use in patients witharteriosclerosisdue to the risk of sudden death.
• Methamphetamine and methylphenidate are contraindicated for use in patients with cardiac disease. These stimulants can cause increases in blood pressure and heart rate and can lead tomyocardial infarction和不明原因猝死(SUD)。Methamphetamine also has a Black Box Warning for this reason.
• Dextroamphetamine/amphetamine, dextroamphetamine, dexmethylphenidate, methamphetamine, and methylphenidate are contraindicated in people withglaucomadue to the risk of visual disturbances and blurred vision. This is because stimulants can block the outflow ofaqueous humor(eye fluid) and increaseintraocular pressure.
• Atomoxetine is contraindicated in closed-angle glaucoma due to the risk ofmydriasis(pupildilation).
• Methylphenidate (Metadate CD) contains sucrose and is contraindicated in patients with hereditaryfructoseintolerance, glucose-galactosemalabsorption, and sucrase-isomaltase deficiency.
• Stimulation of thesympathetic nervous systemby dextroamphetamine/amphetamine, dextroamphetamine, methamphetamine, and methylphenidate can cause cardiac arrhythmias. Therefore they are contraindicated for use in patients with hyperthyroidism.
• Atomoxetine, dextroamphetamine/amphetamine, dextroamphetamine, dexmethylphenidate, lisdexamfetamine, and methamphetamine should not be combined with monoamine oxidase inhibitors (MAOI) or used within 14 days of stopping an MAOI. Such combinations can cause ahypertensivecrisis.
• Atomoxetine is contraindicated in patients withpheochromocytomaor a history of pheochromocytoma. Atomoxetine can cause serious reactions, including
  • increased blood pressure and
  • tachyarrhythmia in this patient population.
• Dextroamphetamine/amphetamine, dextroamphetamine, and methamphetamine are contraindicated in patients with a history of substance abuse since stimulants can cause physical and psychological drug dependence. Dextroamphetamine/amphetamine and dextroamphetaminealso have a Black Box Warning for this reason.
• Dexmethylphenidate and methylphenidate are contraindicated in patients with tics or Tourette's syndrome (including a family history of Tourette's syndrome) since they may worsen these conditions.

Dexmethylphenidate and methylphenidate should be used cautiously in patients with a history of alcoholism because prolonged administration can lead to physical and psychological drug dependence.

• Dextroamphetamine/amphetamine, dextroamphetamine, and methamphetamine should not be used in patients with cardiac disease. These stimulants can cause increases in blood pressure and heart rate and can lead to myocardialinfarction和不明原因猝死(SUD)。
• 以增加自杀的风险ideation and/or suicidal behavior. Patients should be closely monitored while taking atomoxetine.
• Dextroamphetamine/amphetamine, dexmethylphenidate, lisdexamfetamine, and methylphenidate should be used cautiously in patients with a history of substance abuse because prolonged administration can lead to physical and psychological drug dependence. Dextroamphetamine/amphetamine has a high potential for abuse and is contraindicated for use in this setting.

ADHD can exist concurrently in children withautism. However many of these cases are undiagnosed and are undertreated. A study of 2,000 children treated at autism treatment centers across the US found that more than half of them had symptoms of inactivity and hyperactivity.

• However, only 11% of the children were being treated for ADHD.
• Physicians should screen autism patients for ADHD and develop a treatment plan that addresses both disorders.