How to adjust and manage your child’s ADHD medication

Once your child has been prescribed ADHD medication, that’s not the end of the journey. 

You might be wondering: What are the possible side effects? And what if we need to change the dose? 

Tune in to this episode of Parenting Behavior to get expert advice from host Dr. Andy Kahn on side effects, fine-tuning medication, talking to providers, and more. 

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

Timestamps

(0:39) Side-effects and dosing

(2:52) How and when to tweak medications

(4:57) Questions to ask your child’s provider

(7:02) Other key points on medication 

Related resources

• All about ADHD medication

• How ADHD medication works

• Types of ADHD medications   

Episode transcript

Andy: Once your child has been prescribed ADHD medication, that's not the end of the story. You might wonder, what do I need to watch out for? What might be changing?

This is "Parenting Behavior," with me, your host, Dr. Andy Kahn. I'm a licensed psychologist and parent with over 20 years experience navigating behavioral challenges with kids. Today we're going to pick up where we left off last episode, talking about medications, side effects, and how to help your child get their treatment for ADHD. You'll learn about what side effects to watch out for, when and how to change doses, and when to discontinue the medications.

(0:39) Side effects and dosing

OK, let's talk about side effects and dosing of ADHD medications. When it comes to finding the right medication for your child, it may take some time and some effort to find the right dosage and the right medication itself. So, therefore, it's really important to set your expectations accordingly. Physicians will often say to me that changing dosage or medication is extremely common and many kids and families will find that they will try a variety of medications before they find the one that works best for them.

Both stimulant and non-stimulant ADHD medications come with side effect profiles. Prior to beginning any medication for ADHD. Both the American Academy of Pediatrics and the FDA recommend that physicians take a good medical history and understand their child's health history in advance of prescribing medications for ADHD. The most common side effects observed with stimulant medications may include things like reduced appetite, weight loss, headaches, mood changes, sleep problems, and symptom bounceback after the medications have worn off.

The most common side effects with non-stimulant medications may include lower blood pressure or lowered heart rate, sleepiness, decreased appetite, dry mouth, nausea, vomiting, and fatigue. Yes, I know that these all sound pretty scary. Having a conversation in advance with your doctor can be really helpful because many of these side effects could reduce over time when you have the right medication for your child.

Because the impact of non-stimulant medications tend to affect more aspects of body functioning, physicians do not recommend that you take your child off medications when they're out of school on summer vacations. These medications really need to be managed very differently. And a good conversation with your physician will help you figure that out.

If your child experiences side effects that are limiting some daily activity or functioning. Immediately contact your provider to know what to do. For most kids, side effects tend to fade over time, particularly as the medication dosage is adjusted to their positive need. Medication managers will commonly start with lower dosages for kids and build up to a therapeutic dose over time. So be mentally prepared for that as you get involved in the management process.

(2:52) How and when to tweak medications

Let's talk about tweaking medications as well as side effects. Finding the correct dose can be one of the trickier parts of ADHD medications for kids. There are some common signs to look for in a child that might mean that they're in need of a tweak of their medications. First, if your child experiences changes in focus earlier in the day than you've noticed before, it may be time to talk to their physician. In addition, you may see that if your child's morning dose is starting to wear off too early and you're noticing that they're inattentive at noon instead of 2:00, this is a sign that maybe they're growing, they've gained weight, or that their body is adapting differently to the medication.

Also, sleep issues are a top topic to talk to your doctor about because sometimes kids will crash during the day and when the medication wears off, they'll immediately look sleepy and have difficulty activating and managing themselves. Other times, medication can last too long and make it really difficult for them to wind down and fall asleep.

Irritability or emotional changes can also occur, and these might lead your doctor to suggest maybe changing their medication or tweaking their dosage. I do want to make a note of one of the common ADHD myths is that ADHD medications can change the personality of a child. This is not something we observe. Changes in their emotional functioning or emotional regulation are things that we do see, but they're not changing your child's personality.

Remember, fine-tuning the medication dose for your child or finding the right option for treating them can be a challenging journey for some. Gathering information from your child's teachers in addition to family members can provide you with a greater amount of information across the day and allow you to really get a sense of how well they're being impacted throughout the course of their daily activities.

Finally, using things like ADHD symptoms scales, which you can often get from your primary care provider or from your child's therapist if they have one, are great ways to gather data over time to decide how well is this working? What symptoms are being affected? And finally, be patient. Working through this process can take time. But by working with your provider, it can really pay off for your child.

(4:57) Questions to ask your child's provider

If you're unsure about what to expect and feel nervous about how your child may respond to medications, here are a few questions you may want to ask your doctor right away. First, if my child is reacting in a way that I don't like to their medications, how long should we wait before trying something new or discontinuing it? This question may have different answers depending upon if it's a stimulant or a non-stimulant.

For stimulant medications, your doctor may have a much quicker decision for you. But for non-stimulant medications, remember they take more time to work for a child. So, please wait to talk to your doctor before making any significant changes to medications or discontinuing them without advice.

What tweaks or changes can we make to how our children take their medication for ADHD? These are questions to ask in advance with your doctor as much as you can. So, for example, what's the best way for your child to take the medication? Can they take a liquid, a pill, a capsule, a dissolving tab? Can we break up the capsule over their food?

Also, when is the best time for them to take their medication? Should they take it before food, after food, or during a meal? Some of these tweaks may also include things like taking the medication a little earlier in the morning versus right before they go to school. Keep in mind that only doing these tweaks with doctors' advice is important.

So, for things like melatonin at bedtime, for a child who is struggling to sleep, this may be an herbal supplement, but it's something your doctor really should be giving you advice on before you try it on your own. And finally, asking your doctor "What do we do when my child misses a dose of medication?" Ultimately, the process of getting medications just right for your child can take some time. And it does change as they grow, as they gain weight, and as they mature.

Being mentally prepared for these shifts and being aware that you may need to have these changes as part of their protocol can really help you have appropriate expectations and navigate this process a little more easily. When ADHD medications are effective for kids, they can make really significant improvements in their symptoms and functioning, and it also provides a great opportunity for them to learn new skills and to do things that they weren't able to do before without help.

(7:02) Other key points on medication

Before we go, there are a few things that I want to mention. First, and it may seem obvious, that taking medication isn't a simple fix to anything. It should be part of your child's treatment protocol. So, let me be clear. As a psychologist, I often prefer to work on teaching skills to kids before talking about medications. But in the case where symptoms may be more severe, families may need to look at medications first in order to get your child access to skill-building services. Every parent has to make their own decision in this regard, and you've got to determine what's safest and best for your child or children.

One thing that's hard for some families is that not all prescribers will provide medication right away. Some may require you to get an evaluation or to start in therapy first, and this can be really helpful so that you can determine what your child needs most right away. Other things to understand are that meds are a tool and they can't provide your child with skills. Meds are a tool that can help your child be more available and attentive for learning activities. So, obviously things like socialization and other activities will only happen better as the medications work.

Finally, pills don't teach skills. We have to understand that some kids may not be available or have access to their neurology in order to learn the things they need to. And that's where meds come into play so we can teach them what they need. Present research indicates that a combination of medications plus therapy provides the best outcomes. So, if your medication provider isn't recommending therapy or isn't encouraging you to do some skill-building, it's really important to ask why.

In addition, therapy can be really important and helpful to your child in learning new habits. It can also help them be aware of their own symptoms and become more able to be self-aware and self-advocate, which is really crucial for thriving as they get older.

Additionally, ADHD medications aren't a cure-all, and they're not a performance enhancer. For the most part, they really give your child an opportunity to manage symptoms so they can learn new skills. I want you to think of it like this. ADHD is what causes the challenges for your child in doing organizational tasks and in staying focused. ADHD medications are not going to make your child more organized. At best, they'll give your child an opportunity to show the skills they have or to learn the skills they need to to be more organized.

ADHD medications aren't a performance enhancer. If you don't have ADHD, ADHD meds are not going to be helpful to you. Certainly, people do abuse ADHD drugs for things like weight loss or staying up late, but they are not helpful to people who don't have ADHD. I also want to make note of something that's been happening over the last several years, and that's the shortage of stimulant medications for ADHD. for a variety of causes. There have been shortages of stimulant-class medications across a variety of name brands and generic meds.

Now, this has left many people across the country and the world unable to refill their prescriptions. Suddenly discontinuing stimulant medications due to limited availability or other causes can lead to negative physical impacts for some people, and it can also cause a return of worsening ADHD symptoms. So, having conversations with your medication provider in advance is really important for creating a plan for what are you going to do if your med is not available or maybe you choose an alternative medication that isn't part of the shortage.

Keep in mind that not all insurance companies will authorize all types of ADHD medication, so making sure your provider has access to that list in advance can be really important in making those selections for you and to make sure you have access to the meds that you need.

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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