How ADHD medication works

ADHD medication is certainly a controversial issue. There is just SO much to be said on the matter. In this article I’ve tried to cover the topic of ADHD medication  as comprehensively as possible, while still trying to keep it short and relevant.  So here goes:

What types of medication are available?

Essentially, there are 3 types of ADHD  medication available in South Africa.  These are Ritalin, Concerta and Strattera.  Ritalin and Concerta are stimulant medications with Methylphenidate Hydrochloride as the active ingredient. Strattera is a non-stimulant medication with Atomoxetine Hydrochloride as the main ingredient.

Stimulant medications (Ritalin and Concerta) begin to take effect shortly after they have been ingested. Whereas the non-stimulant medication (Straterra) needs to build up in a child’s system. So Straterra will need to be taken for about 4 weeks before it starts taking effect.

Why give a child stimulant medication?

You might be thinking that it seems strange to give a hyperactive child stimulant medication – right?  Well, it’s not really.  You see, put in very simple terms – the brains of children with ADHD are generally under-stimulated. Think of it in the following way. When you are focused on a task, like reading for instance, your brain is not only busy reading.  It is also doing lots of other things in the background. Like making sure you breathe, monitoring your heart rate, filtering information received through your skin, etc. Think as these things as background noise. In ADHD children the neural pathway responsible for keeping the attention focused on the reading task is inefficiently stimulated.  And so the messages from these pathways get drowned out by the “background noise”.  Stimulant medication helps to amplify the reading-message so that it gets passed on effectively through the relevant neural pathway .

How exactly does it work?

For years we’ve know that stimulation medication works for ADHD children. But we’ve never really understood how it works.  Now researchers have finally solved this mystery.  It seems that the brains of children with ADHD have too little Dopamine. Dopamine plays an important role in movement, attention, motivation and reward.  It signals to the brain that something is important and that the brain should pay attention.  Now, it’s not that ADHD children’s brains don’t produce enough Dopamine.  Rather the problem is that it re-absorbs the Dopamine it has produced too quickly.  Because of this, there is not enough Dopamine available to the neural pathways where it is needed.  Stimulation medications helps to stop the re-absorption of Dopamine so that it is available to the brain for longer.

Are there side effects?

Yes – sometimes.  The most common side effects of stimulant medications include head aches and stomach aches. But these usually only occur on the first few days of taking the medication and are transient.  Another, more worrying side effect of the medication is appetite suppression and accompanying weight-loss.  It is not unusual for a child on stimulant medication to return home after a long day at school with a full lunchbox.  Many parents try to overcome this by ensuring that the child eats a big breakfast and only giving them their tablet after breakfast.  Getting them to eat lunch often requires some negotiation skills. But the medication has usually worked out by dinner time and then the child eats well again. Sometimes we see a rebound appetite and the child eats ravenously at dinner time. Making up for everything he missed out on earlier in the day.

How long does it work for?

Various medications are effective for varying amounts of time:

Ritalin Short Acting (SA) works for about 4 hours.

Ritalin Long Acting works for about 8 hours

Concerta works for about 10 – 12 hours.

One of the problems with Short Acting (SA) Ritalin is that is has often worked out by the time the child gets back from school and is required to do his homework.  Some parents report that their children become very emotional in the afternoon. But this is most likely due to the fact that they were able to cope well during the school day because of the Ritalin and then battle to concentrate during homework time when the drug is no longer in their system. So they may become tired, frustrated and irate.  Some doctors may try to overcome this problem by prescribing a second Ritalin tablet to be taken in the afternoon. However, this may result in difficulties sleeping at bedtime because the stimulant medication makes them feel wide awake.

Concerta is slightly different to Ritalin in that it has a prolonged release mechanism – it releases a small amount of medication straightaway and the rest of the medication is then released as the rest of the tablet dissolves .

Does my child have to take the medication everyday?

Doctors disagree as to the practice of taking “medication holidays” – not taking medication while on holiday or over weekends. Some feel that it is absolutely fine  for children to only take the medication on academic days and to try and recoup their appetites over the holidays. While others feel that taking the medication everyday ensures that concentration levels remain optimum and so ensures that the brain learns to function correctly.

Strattera (non-stimulant) works in almost the same way as the stimulant medications by preventing the re-absorption of certain neurotransmitters in the brain. But Strattera prevents the brain from re-absorbing Nor-epinephrine and not Dopamine.   Nor-epinephrine also plays a role in attention.  Strattera generally works for a full 24 hours with one dose a day. But it is not possible to take “medication-holidays” while on Strattera.  The tablets need to be taken every day to allow Nor-epinephrine levels to build up sufficiently.

How do we know which type of medication is right?

It is important to remember that medication is NOT a once size fits all approach. Certain drugs simply work best for certain people.  There are also various others factors to take into consideration.  These include the severity of the problem and the child’s body weight and height. Parents may feel rather frustrated initially as their child may be placed an a “trial” of medication and the medication and dosage may then be adjusted by the Pediatric Neurologist based on feedback from home or from the school. But finding the right medication and the right dosage for your child is vitally important as it will most likely result in the least side-effects.

Will my child become addicted to ADHD medication?

Studies conducted to date have not shown a link between using ADHD medication and developing drug addiction later in life.   In fact, some studies have shown that ADHD children who are NOT medicated are more likely to turn to illegal drugs in an effort to “self-medicate” their concentration difficulties.

Is ADHD medication all about getting children to perform better academically?

No – keep in mind that ADHD does not only affect academics.  Because children with ADHD can often be impulsive and boisterous. And these behaviours might be affecting their social interactions too.   ADHD children may often do things or say things to their friends without thinking of the consequences.

It can also affect a child’s self esteem in several ways.  Children with ADHD are often constantly in trouble with their teacher and may get scolded often.   Classmates might not want to befriend a child who is constantly in trouble with the teacher because they do not want to get into trouble by being associated with the “naughty” child.  A bright child might realise that she is not coping academically and might incorrectly start to believe that she is “stupid”. Sadly this often becomes a self-fulfilling prophecy.  On the plus side: we often see self-esteem issues and social interactions improve after a child has started taking ADHD medication.

Now keep in mind that as a psychologist I cannot prescribe medication. Also, this article is by no means exhaustive.  If you have any questions regarding your child’s ADHD medication I would recommend that you contact a psychiatrist, neurologist or other medical professional in this regard.

ADHD or ADD?  Read this article to understand the difference.