The drugs usually prescribed to treat ADHD are generally effective and safe. Most children and teenagers (60 percent to 80 percent) who take them become less hyperactive and impulsive, are better able to focus, and are less disruptive at home and school. But there is no good evidence showing that these benefits last longer than about two years, and the long-term consequences of taking stimulants for years on end have not been fully evaluated in studies.
Fortunately, many children with ADHD—even when they are not treated—improve as they reach the teenage years and early 20s. But the disorder can persist into adolescence and adulthood about 30 percent to 70 percent of the time.
All of the ADHD stimulant medicines have been linked to rare cases of heart attack, stroke, and sudden death, so children should first be evaluated for underlying heart problems.
The severity of symptoms and abnormal behavior patterns in children and teenagers with ADHD varies widely. Diagnosis, too, can be quite subjective, varying from doctor to doctor. Because diagnosis of the condition can be difficult, and a variety of medical and psychiatric disorders can cause symptoms that mimic ADHD, many children and teenagers taking medication might not have ADHD or have only mild symptoms that do not require it. Be sure to get a diagnosis from a physician or mental-health professional with expertise in ADHD and a second opinion if you have doubts. Even if your child meets the criteria for ADHD, he or she might not need a drug. A pediatrician can refer you to a mental-health specialist (some specialize in ADHD), who should begin by ruling out other possible reasons for the behavior.
The most effective strategy for treating ADHD consists of more than one approach. There is some evidence that the combination of behavioral therapy with medication can work better than drugs alone for some children. But behavior therapy alone does not work for all children, especially those who have severe symptoms.
As with most disorders for which multiple medications are available, there are no definitive comparison studies to show which ones work best in specific circumstances, according to Michael L. Goldstein, M.D., a child neurologist with Western Neurological Associates in Salt Lake City, and a former vice president of the American Academy of Neurology.
Two classes of medication are available for treating ADHD:
- Stimulant medications, such as dextroamphetamine-based drugs (Adderall, Vyvanese) and methylphenidate-based drugs (Concerta, Daytrana, Ritalin). They are also available as generics.
- Nonstimulant medication, such as the antidepressant bupropion (Wellbutrin and generic) or atomoxetine (Strattera), which is not available as a generic.
Those medicines don't cure ADHD but they can keep symptoms under control, which may improve a person's daily functioning. Each raises different safety issues, however, which your doctor should discuss with you. Dosing convenience (taking one pill a day instead of two or more; oral solutions for those who have difficulty swallowing tablets; or the use of a patch) and how long the medicine is active are critical elements of ADHD treatment. You should be skeptical if a doctor or therapist diagnoses ADHD at the first visit and immediately prescribes a drug and should seek a second opinion.
The stimulants are controlled substances, while Straterra is not. Fewer restrictions apply to prescriptions for Straterra, and some parents think that makes it safer. If families are worried about using a controlled substance for children, Straterra might be more acceptable, Goldstein says, although many professionals think it might be less effective.