ADHD medication for kids: Stimulants vs. non-stimulants

Are you considering medication for your child with ADHD but need more information?

In this episode of Parenting Behavior, host Dr. Andy Kahn gives an overview of ADHD medications for kids. He shares the ins and outs of stimulant and non-stimulant medications, what the research says, and important side effects to consider.

Tune in to learn more about ADHD medications and how to get medication management services for your child.

We’d love to hear from you. You can email us at ParentingBehavior@understood.org.

Related resources

• All about ADHD medication

• How ADHD medication works

• Types of ADHD medications   

Timestamps

(1:16) An important disclaimer

(2:12) Stimulant medications

(04:19) How stimulants work

(6:36) Non-stimulant medications

(08:11) Getting medication management services for your child

Episode transcript

Andy: So, you're thinking about ADHD medications for your child? Perhaps the doctor mentioned it or is something you're just curious about. If you've been wrestling with your child's treatment and behavior needs for some time, obviously, the idea of medications can generate a lot of feelings and emotions for you.

For some parents, this can be an exciting time filled with lots of optimism and hope. For other families, this can feel like a surrender or that they feel like they're even poisoning their child. So, take heed. Admittedly, this is a scary time and generates a lot of emotion and feeling for families, and this can only be managed with the right combination of information and advice. So, today I want to sift through the wealth of information you may have already been exposed to and read online to help you understand what you need to know, or at the very least, how to generate good questions for your providers.

This is "Parenting Behavior," with me, your host, Dr. Andy Kahn. I'm a licensed psychologist with over 20 years experience working with kids and families. I'm also a parent. Today we're going to focus on ADHD medications: A brief overview.

(1:16) An important disclaimer

So, very important. We're going to do a caveat here and a disclaimer. First and foremost, it's important to know that Understood is not in any way affiliated with the pharmaceutical industry or people who sell or manufacture medications. Today is entirely for informational purposes. The reason I'm sharing this episode is not to give you medical advice and is not a substitute for medical advice, but rather to have a conversation with you, much in the way I've had with my own clients about medications, the research, and what they may want to research themselves with their providers.

Finally, as a psychologist, I need to emphasize I'm not a medical doctor. I can't prescribe medication or give you direct medical advice. But I can have conversations with you here today, much like I do with my own clients, sharing the research and information so that you can make good decisions for yourself with the support of your physician. OK, let's get started.

(2:12) Stimulant medications

Today, we're going to be talking about the two classes of medications for ADHD, stimulants and non-stimulants. First and foremost, let's start with stimulant medications. Stimulant medications have been used since the 1930s to navigate child behavior and help kids who are emotionally dysregulated. But they really didn't start to be used in earnest until the 1960s for ADHD.

One of the things that we know is that stimulants tend to work in a paradoxical way. That means they sort of work in the opposite direction to what we would think. I know it's a little weird, but stay with me. Stimulant medications help regulate the brain in terms of things like self-regulation, attention, focus, and concentration. So, when you add a stimulant to an overstimulated brain, we actually often see things like improved attention, concentration, and emotional regulation.

Modern stimulants have progressed a lot since just Ritalin was available. Today, stimulant medications can be short-acting, which is maybe 2 or 3 hours of activity compared to extended-release or long-acting medications, which can last 5 or 6 hours up to all day. ADHD medications have been the focus of many studies evaluating their effectiveness and safety with generally positive results.

It's very important to understand that to safely use these medications, you need to carefully discuss your child's personal health and functioning status with your physician. In this way, you can personally determine what are the risks and benefits to using medications with your child. A word of caution: long-term effects of some of the newer medications have not been fully studied yet. So, for many families, these medications may be something they and their doctors only consider after trying some more well-established medications with longer research histories.

Stimulant medications are generally recommended as the first-line medications, since they tend to have the highest effect size, meaning that when they work, they significantly reduce symptoms at a greater level than non-stimulant medications. Generally speaking, stimulants work by targeting the brain's dopamine and norepinephrine. These are chemicals that are known as neurotransmitters. These affect things like attention, focus, motivation, movements, and stress responses, just to name a few.

(04:19) How stimulants work

Some stimulants may take effect really quickly, like within 30 minutes, and others may take a lot longer to get activated in your body, perhaps up to 90 minutes. Some stimulants may take effect really quickly within 20 or 30 minutes. Others may take up to 90 minutes to be effective. One thing to keep in mind when using shorter active medications, they may only last 2 to 3 hours. Your child may need to have multiple doses during the course of a day to have the impact that you'd like.

Longer-acting or extended-release medications can last up to 5 or 6 hours or for a full day for some kids. It's important to keep in mind that when we talk about common names of stimulant medications, that there are lots of brand names and generics out there. So, common stimulant names may include Ritalin, Focalin, Concerta, Adderall, and Vyvanse. These are all specific brand or company names. We've created a document in the show notes that will give you more information about specific medication names and data associated with them.

Current research indicates that approximately 70 to 80% of people who take stimulant medications for ADHD have a positive response. Keep in mind that when someone says that stimulant medications don't work for them, it means that they're not having the positive response that they would expect. Or perhaps the side effect profile is preventing them from benefiting from the medication.

An important caveat here: Failure to respond to stimulant medications does not mean your child doesn't have ADHD. It just means that their particular body is not responsive to that medication. Finally, when medications for ADHD are prescribed, you and your provider should have a plan in place to monitor both the effect and the possible side effects. Things like decreased appetite or trouble falling asleep.

If the side effects of the medication are mild but the positive symptom impact is also noted, it may be worthwhile to talk to your physician about keeping that medication in place while trying to let the side effects fade, which happens for some kids.

Another thing to keep in mind is that if side effects become too intrusive or they affect your child's functioning like worsening mood, it may be really important to talk to your doctor about a discontinuation of that medication or making a change. Please don't make changes like that on your own. Your doctor can give you appropriate advice to protect your child's health.

(6:36) Non-stimulant medications

Now on to non-stimulant medications. Over the last 20 years, a variety of non-stimulant medications for ADHD have been developed. Many parents consider the use of non-stimulant medications for a variety of reasons. First and foremost, they're worried about the impact of stimulant medications on things like weight loss or sleep challenges. Second, non-stimulants may be a preferred choice for parents who really aren't comfortable with the use of stimulants.

Third, when kids don't respond to stimulant medications as a first line of attack, using non-stimulants may give them an opportunity to seek some positive benefit. And finally, if a child experiences really significant side effects from stimulants, non-stimulants often become a really good option.

There are two main categories of non-stimulant medications. The alpha agonists like Tenex or Kapvay or selective norepinephrine reuptake inhibitors — that's a mouthful — like Strattera. Nor epinephrine reuptake inhibitors like Strattera, again, work by increasing a brain chemical called norepinephrine. It's a neurotransmitter that's linked to attention or inattention, in this case.

The alpha agonists like Tenex and Kapvay are adapted from blood pressure medications and they're designed to lower the overall reactivity of the human body to help calm the body and calm the challenges kids may have with energy or attention. Unlike stimulants, non-stimulant medications can take anywhere from 4 to 6 weeks to become effective. So, that's really important to keep in mind.

And finally, there's a link in the show notes to talk more about examples and details about both stimulants and non-stimulant medications.

(08:11) Getting medication management services for your child

Before moving on, I want to briefly mention how you go about getting medication management services for your child. In almost every state, prescribers need to be medical doctors or nurses with specialized training. So that might include nurse practitioners or advanced practice registered nurses. If you're interested in seeing if medication could help your child's ADHD, talk with your primary care provider, who will be able to help you or refer you to a professional who can.

OK. That's all for this episode. But we're going to continue this discussion on ADHD medications next time on "Parenting Behavior." On that episode, we're going to go over side effects, dosing, and fine-tuning medications.

Thanks for listening to this episode of "Parenting Behavior with Dr. Andy Kahn." We'd love to hear from you. If you have thoughts on this episode or any of our other shows, you can reach out to us at ParentingBehavior@understood.org. I'll put that email in the show notes, too, where you can also find more resources and links to anything we talked about today.

"Parenting Behavior with Dr. Andy Kahn" is brought to you by Understood.org. It's produced and edited by Cody Nelson. Editorial guidance by Gail Belsky. Music and mixing by Justin D. Wright. Our video producers are Calvin Knie and Christoph Manuel. Special thanks to Dr. Karen Wilson. Ash Beecher is our supervising producer. Briana Berry is our production director, and Neil Drumming is our editorial director. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick.

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