• Mental Health

Treating ADHD in Children

The Food and Drug Administration has approved two types of medications—stimulants and non-stimulants—to help reduce the of ADHD and improve functioning in as young as 6 years.

Stimulants have been the tried and true medication for ADHD since the 1950s. They have a long track record of being safe and effective. Despite their name, stimulants— which contain various forms of methylphenidate and amphetamine— actually have a calming effect on hyperactive children with ADHD. They are believed to increase levels in the brain of dopamine— a neurotransmitter associated with motivation, attention, and movement.

There are three non-stimulants to treat the symptoms of ADHD: (atomoxetine), Intuniv (), and Kapvay (clonidine). These provide a useful alternative for children. Some children do not tolerate stimulants well, and the non-stimulants do not have the same side effects.

Although stimulants are generally safe when taken as directed, FDA found 19 reported cases in a 5-year period of sudden death in children who took stimulants for ADHD. Roughly half of these children were also reported to have underlying structural heart defects, which raised a concern that the use of stimulants in such children might increase the risk of sudden death. In 2007, FDA required the drug label for all medications approved to treat ADHD—not just stimulants—to warn of this possible risk.

A large, recently completed study showed no evidence that ADHD drugs are associated with an increased risk of cardiovascular events (such as stroke, heart attack, and sudden cardiac death) in children and young adults. The medications studied include stimulants and the non-stimulants Cylert (pemoline), which is no longer sold, and Strattera. The study was sponsored by FDA and the Agency for Healthcare Research and Quality , another agency of the U.S. Department of Health and Human Services.

Medications do not cure ADHD, but control the symptoms. Some children outgrow ADHD but medication is generally given through high school. No matter what drug is taken, it’s important to have the child regularly checked by the pediatrician. A study of nearly 600 children, ages 7 to 9, concluded that ADHD with medication alone was more effective than behavioral therapy alone. The NIMH-sponsored study also found that behavioral therapy combined with medication was not more effective than medication alone to treat most ADHD symptoms. However, the behavioral therapy was useful in helping to manage and modify some problem-causing behaviors. In addition, some children getting a combination of therapy and medication ended up taking lower doses of medication than those tak- ing medication alone.

Consequences of Not Treating

Left untreated, ADHD can have serious consequences.

A child may fall behind in school, have difficulties that interfere with friendships, and have conflicts with parents.

Studies show that children with untreated ADHD have more emergency room visits and are more likely to have self-inflicted injuries than those treated for the disorder. Untreated adolescents with ADHD are more likely to take risks, such as drinking and driving. And they have twice as many as those who are treated.