Stimulant ADHD Medication - Amphetamine and Methylphenidate for Children

Introduction

‍Attention Deficit Hyperactivity Disorder (ADHD) is not limited to children; it can persist into adulthood, affecting millions of adults worldwide. ADHD can bring challenges in various aspects of life, including work, relationships, and daily functioning. While conventional treatments like medication and therapy are commonly prescribed, some adults with ADHD explore alternative options, such as homeopathic remedies. However, one thing is certain: there are many highly successful people who have ADHD.

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Children with this disorder may show symptoms of hyperactivity, inattention, and impulsivity. These manifestations can impact a child’s daily life, especially in their school and social settings. While ADHD can be challenging to manage, medications such as amphetamines and methylphenidates have been effective in alleviating the symptoms. This article explores the use of amphetamine and methylphenidate medications for children with ADHD, their mechanisms of action, benefits, potential side effects, and considerations for parents and healthcare providers.

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Understanding ADHD in children

To aid understanding of ADHD, it is important to recognize the causes of the disorder. It is said to have a complex aetiology, suggesting the implication of genetic, environmental, and neurobiological factors. The symptoms of ADHD can also vary from child to child, suggesting the importance of tailoring a treatment plan as per the child’s concerns. The common symptoms of ADHD in children include inattentiveness, hyperactivity, and impulsivity.

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The diagnosis of ADHD is based on specific criteria outlined in the diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases. Mental Health Professionals take detailed developmental history of the child. They would also use rating scales. 

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Non-medical treatment of ADHD in children

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Non-medical interventions for treating ADHD in children are diverse and tailored to individual symptoms. Psychotherapy focuses on emotional management and self-esteem, while behavioral therapy equips parents and teachers with strategies for behavior change. Regular exercise, promoting neurotransmitter release, enhances attention and coordination. Dietary changes involve reducing sugars and additives, with recommended supplements like Vitamin B and omega-3. Holistic approaches aim at fostering overall well-being, emphasizing the importance of a balanced diet for growing children.

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Medication-based treatment of ADHD in children

Provision of medication to children with ADHD can help manage their symptoms. They also help to control disruptive behaviours. These medications are divided into stimulants and non-stimulants. 

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Stimulant medication for ADHD works by boosting communication between nerves in the brain. They increase levels of neurotransmitters such as dopamine and norepinephrine. These aid the ability to pay attention, increase motivation, and improve the ability to think. 70-80% of children with ADHD report having more manageable symptoms after being matched to the correct medication and dosage. 

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Stimulants are available as immediate release (short acting) or extended release (intermediate acting or long acting). Short-release stimulants are taken as needed and last for around 4 hours. When the effects of the medication wear off, individuals experience a “the rebound effect.” This leads to decrease in energy levels, a drop in mood, and severe hunger. Extended-release stimulants are taken once in the morning, and they last between 6-16 hours. They cause fewer ups and downs as compared to short-release stimulans and reduce the need for extra doses.Stimulant medication for ADHD involves two classes of drugs: methylphenidates and amphetamines. 

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Amphetamines are stimulants which release dopamine and norepinephrine in the central nervous system. These help to regulate attention, focus, and impulse control. This class of medications include Adderall (a combination of amphetamine and dextroamphetamine salts) and Vyvanse (containing lisdexamfetamine). The medications are available as immediate-release and extended-release formulations and provide symptom release for 4-14 hours. Amphetamines have the following benefits for children with ADHD:

• Improved focus and attention: Amphetamines can enhance the child’s ability to pay attention and concentrate, which can be very helpful in classrooms.
• Reduced hyperactivity and impulsivity: These medications help children control their impulses and other hyperactive behaviours. This can lead to improved school performance and social interactions. 
• Better executive functioning: Functions such as planning, time management, and organisation can be improved by using amphetamines for treating ADHD. 
• Quick onset: The immediate-release formulations of amphetamines can allow for rapid symptom relief, so the dosing can match the child’s specific needs. 

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The other class of stimulants prescribed to children with ADHD include methylphenidate. Like amphetamines, these drugs also work on neurotransmitter levels in the brain, increasing the availability of norepinephrine and dopamine. Common short-acting medications are available under the brand name of Ritalin and Focalin, which work after 30-45 minutes after taking them, and last for 3-4 hours. Longer acting methylphenidates are available under the brand name of Concerta, Metadate CD, Ritalin-LA, Aptensio XR, and Focalin XR. Quillivant XR is also a liquid methylphenidate, and a good alternative to the tablet medications.

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Quillichew ER is a long-acting chewable form of methylphenidate. Lastly, Daytrana is a methylphenidate patch which can be stuck to the child’s body. This allows the medication to be absorbed into the bloodstream and is effective until they are taken off. These medications last between 8-12 hours. Methylphenidate has the following benefits:

• It is less potent than the amphetamine class of medications.
• The extended release formulations provide steady symptom control, reducing the need for the child to take multiple doses.
• Improved academic performance: Methylphenidate has been shown to enhance a child’s ability to follow instructions, complete tasks, and stay on track for assignments.
• This class of medication also has a lower potential for abuse, compared to amphetamines. 

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When considering switching to prescribed medication for ADHD, it is also important to be aware of the side effects. Common side effects include:

• Loss of appetite: This happens when the medication wears off, and causes the child to experience irritations and grouchiness. 
• Sleep problems: Children who take stimulant medications might find it hard to go to sleep, especially with younger children. This can be managed by understanding the factors causing sleeping issues, or moving to short-acting formulas, which wears off by bedtime.
• Wear-off effects: Some children also experience rebound effects as their medication wears off. The intensity of this varies from child to child, but it causes them to be irritable and emotional.
• Mood changes: If a dose of stimulant medication is too high for the child, they may appear tearful. This can be managed by changing the dosage of the medication. 
• Some children also experience changes in blood pressure and heart rate. 

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Non-stimulants use different active ingredients to manage the symptoms of ADHD. They are often prescribed when stimulants don’t work or if they have intolerant side effects. These medications are also considered when the child has other psychiatric comorbidities such as anxiety disorder or Tourette’s, which might be negatively impacted by stimulant medication. Non-stimulants include antidepressants such as , tricyclic antidepressants, alpha-2 adrenergic agonists such as Intuniv and Kapvay, and Atomoxetine. 

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Conclusion

Amphetamine and methylphenidate medications have proven to be valuable tools in managing the symptoms of ADHD in children. When prescribed and monitored carefully by healthcare professionals, these medications can provide substantial benefits, including improved focus, reduced hyperactivity, and enhanced executive functioning. However, it's crucial to remember that medication is not a one-size-fits-all solution, and the choice of medication and dosage should be tailored to each child's unique needs. Caregivers need to be aware of the side effects, abuse potential, and individual response of the child.

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Parents, caregivers, and healthcare providers can work together to create a comprehensive treatment plan that includes medication, behavioural interventions, and educational support. Regular monitoring and open communication are essential to ensure that children with ADHD receive the most effective and individualised care possible, enabling them to thrive and reach their full potential. Such a treatment plan can be formulated alongside the team of experts including psychiatrists and psychologists at Rocket Health. 

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References

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‍Advokat, C. & Scheithauer, M. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Frontiers in Neuroscience, 7(82). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666055/.

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Boorady, R. (2023, February 1). “Stimulant medications for ADHD.” Child Mind. https://childmind.org/article/understanding-adhd-medications/

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‍Attention-deficit/hyperactivity disorder (ADHD) in children. (2019, June 25). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/drc-20350895

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‍Krinzinger, H. et al. (2019). Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience & Behavioural Reviews, 107, 945-968. https://www.sciencedirect.com/science/article/pii/S0149763419302350

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‍Lara, M. (2018). “The exercise prescription.” CHADD. https://chadd.org/wp-content/uploads/2018/06/ATTN_06_12_Exercise.pdf    

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Therapy for childhood ADHD. (2023, April 18). WebMd. https://www.webmd.com/add-adhd/childhood-adhd/adhd-behavioral-treatment

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‍Treatment of attention deficit hyperactivity disorder (ADHD). (2021, December 24). NHS. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/  

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Van der Schans, J. et al. (2017). Methylphenidate use and school performance among primary school children: A descriptive study. BMC Psychiatry, 17(116). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371237/