date: 10/12/2005
Treating attention deficit hyperactivity disorder
While ADHD drugs are effective and safe, careful diagnosis is needed
Consumer
Reports Best Buy Drugs recommends getting a careful diagnosis before
you or your child begins taking drugs for attention deficit hyperactivity
disorder. Low- and moderate-cost generics, tested by time, are
just as effective as expensive brands.
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Drugs called stimulants are the most commonly prescribed
medicines to treat attention deficit hyperactivity disorder (ADHD). A new
report from Consumer Reports Best Buy Drugs concludes that those
drugs are generally effective and safe for most children and teenagers.
Between 60 and 80 percent of children and teens who take them become less
hyperactive and impulsive, better able to focus, and less disruptive at
home or school.
But the report cautions that the diagnosis of the condition can be difficult and that many children and teens taking stimulants today either do not have ADHD or have only mild symptoms that may not warrant drug treatment.
The report says that the diagnosis of ADHD requires careful consideration. If any doubts exist, a second opinion should be sought. Adults with ADHD also appear to benefit from taking stimulants. But the report notes that far fewer studies have examined the effectiveness of the medicines in this population.
People experience ADHD symptoms with varying degrees of severity. And the diagnosis can be quite subjective, varying from doctor to doctor. But generally, a child, teen, or adult who persistently has six or more of the following symptoms/behavioral patterns (from either list) may have ADHD and be a candidate for an ADHD drug. In children, ADHD is more likely to be diagnosed if the symptoms started before age 7, have been ongoing for at least six months, and there is disruption at home and school.
The stimulants discussed in this report have the potential for abuse. Teens and college students take them to pull "all-nighters" and be more mentally alert and focused for exams. Since stimulants also suppress appetite they have been used by people trying to lose weight as well.
Various studies have pegged the school-related abuse incidence at up to 7 percent of ninth-graders (who had ever abused stimulants illicitly, even once) and up to 17 percent of male college students and 11 percent of female college students (again, who had ever used a stimulant without a prescription).
"Hard core" abusers have also been reported to crush and snort stimulant pills or dissolve them in water and inject the solution. Severe complications can arise from this practice because insoluble fillers in the tablets can block small blood vessels in various organs of the body.
Dextroamphetamine appears to have a greater potential for abuse than methylphenidate. But addiction to methylphenidate can and does occur. Snorting in particular can induce large and fast dopamine increases in the brain. Used this way, the drug has effects similar to but more potent than caffeine, but less potent than amphetamines. It does not induce the subtle euphoria and psychic energy of cocaine, but some abusers tell of being more energetic, less distractible, and better able to focus. A form of withdrawal-similar to a caffeine comedown-can occur with intermittent use.
The risk of addiction among children and preteens taking stimulants for ADHD is very low and has not generally been reported. But tolerance to the drug can build up, requiring higher doses. This makes stopping the drug more difficult. Parents of teens and college students who have been prescribed stimulants for ADHD should closely monitor their children's use of the medicines.
But the report cautions that the diagnosis of the condition can be difficult and that many children and teens taking stimulants today either do not have ADHD or have only mild symptoms that may not warrant drug treatment.
The report says that the diagnosis of ADHD requires careful consideration. If any doubts exist, a second opinion should be sought. Adults with ADHD also appear to benefit from taking stimulants. But the report notes that far fewer studies have examined the effectiveness of the medicines in this population.
- If you or your child is prescribed a drug for ADHD that costs more than $100 per month, discuss that choice with your doctor. You may be paying too much or have a prescription for a brand-name medicine when a generic would do just as well.
- Other types of drugs sometimes used to treat ADHD, such as antidepressants and antipsychotics, lack proof of effectiveness in treating the condition and should be used with caution.
- Parents of older teens and college students should be alert to the illegal use of stimulants obtained without a prescription. The medicines are increasingly being taken by students who do not have ADHD to increase mental alertness and help them stay awake at night to study. See the box below on abuse of ADHD drugs.
- Methylphenidate tablets - 5 mg, 10 mg, and 20 mg
- Methylphenidate sustained-release tablets or capsules (Metadate ER, Metadate CD, and Methylin ER) - 10 mg, 20 mg, 30 mg
- Dextroamphetamine tablets - 5 mg, 10 mg
- Dextroamphetamine sustained-release or long-acting tablets - 5 mg, 10 mg, and 15 mg
The Most Commonly Used Drugs to Treat ADHD
| Generic name | Brand name(s) | Available as a prescription generic drug? |
| Amphetamine | Adderall, Adderall XR | Yes |
| Atomoxetine | Strattera | No |
| Dextroamphetamine | Dexedrine, Dextrostat | Yes |
| Dexmethylphenidate | Focalin | No |
| Methylphenidate | Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin SR, Ritalin LA | Yes |
The Symptoms of ADHD
People experience ADHD symptoms with varying degrees of severity. And the diagnosis can be quite subjective, varying from doctor to doctor. But generally, a child, teen, or adult who persistently has six or more of the following symptoms/behavioral patterns (from either list) may have ADHD and be a candidate for an ADHD drug. In children, ADHD is more likely to be diagnosed if the symptoms started before age 7, have been ongoing for at least six months, and there is disruption at home and school.
Inattention Markers
- Has difficulty paying attention to details
- Makes frequent careless mistakes in schoolwork, work, or other activities
- Has difficulty sustaining attention in performing tasks or play activities
- Has difficulty listening when spoken to directly
- Lacks ability to or is slow in the completion of assignments and tasks
- Has difficulty organizing tasks and activities
- Has difficulty with tasks that require sustained mental effort
- Loses things necessary for tasks or activities
- Is easily distracted by extraneous stimuli or sights or sounds
- Is easily bored
- Is forgetful in daily activities
- Has tendency to daydream
Hyperactivity and Impulsivity Markers
- Fidgets with hands or feet or squirms in chair
- Leaves seat in classroom or in situations in which remaining seated is expected
- Runs round excessively in situations in which it is inappropriate
- Has difficulty engaging in leisure activities quietly
- Is "on the go" or acting as if "driven by a motor" much of the time
- Talks excessively, rapidly, or on impulse
- Blurts out answers before questions have been completed
- Has difficulty waiting turn to speak
- Interrupts or intrudes on others
- Is hot tempered and easily agitated or angered
- Has low tolerance for stress
Be Alert to Abuse of ADHD Drugs
The stimulants discussed in this report have the potential for abuse. Teens and college students take them to pull "all-nighters" and be more mentally alert and focused for exams. Since stimulants also suppress appetite they have been used by people trying to lose weight as well.
Various studies have pegged the school-related abuse incidence at up to 7 percent of ninth-graders (who had ever abused stimulants illicitly, even once) and up to 17 percent of male college students and 11 percent of female college students (again, who had ever used a stimulant without a prescription).
"Hard core" abusers have also been reported to crush and snort stimulant pills or dissolve them in water and inject the solution. Severe complications can arise from this practice because insoluble fillers in the tablets can block small blood vessels in various organs of the body.
Dextroamphetamine appears to have a greater potential for abuse than methylphenidate. But addiction to methylphenidate can and does occur. Snorting in particular can induce large and fast dopamine increases in the brain. Used this way, the drug has effects similar to but more potent than caffeine, but less potent than amphetamines. It does not induce the subtle euphoria and psychic energy of cocaine, but some abusers tell of being more energetic, less distractible, and better able to focus. A form of withdrawal-similar to a caffeine comedown-can occur with intermittent use.
The risk of addiction among children and preteens taking stimulants for ADHD is very low and has not generally been reported. But tolerance to the drug can build up, requiring higher doses. This makes stopping the drug more difficult. Parents of teens and college students who have been prescribed stimulants for ADHD should closely monitor their children's use of the medicines.
About the Consumer Reports Best Buy Drugs project
Consumer Reports Best Buy Drugs is an educational and outreach initiative that compares a variety of prescription drugs on price, effectiveness and safety to help consumers and their doctors identify the most effective and affordable medicines.
The project combines evidence-based research on the comparative effectiveness and safety of prescription drugs with comprehensive nationwide data on drug prices. The information on drug effectiveness is derived from the Drug Effectiveness Review Project (DERP), a 12-state initiative. Price information is based on average retail prices paid in cash by consumers at the pharmacy. Every drug report is peer-reviewed by medical experts in the particular drug category.
For information on other drug categories we have examined to date - heartburn and acid reflux drugs, medicines to treat elevated cholesterol, high blood pressure, depression, arthritis and pain -- visit www.CRBestBuyDrugs.org.
Consumer Reports Best Buy Drugs is an educational and outreach initiative that compares a variety of prescription drugs on price, effectiveness and safety to help consumers and their doctors identify the most effective and affordable medicines.
The project combines evidence-based research on the comparative effectiveness and safety of prescription drugs with comprehensive nationwide data on drug prices. The information on drug effectiveness is derived from the Drug Effectiveness Review Project (DERP), a 12-state initiative. Price information is based on average retail prices paid in cash by consumers at the pharmacy. Every drug report is peer-reviewed by medical experts in the particular drug category.
For information on other drug categories we have examined to date - heartburn and acid reflux drugs, medicines to treat elevated cholesterol, high blood pressure, depression, arthritis and pain -- visit www.CRBestBuyDrugs.org.
This site is for your information only. For medical advice, consult a health professional.
