ABOUT THE AUTHOR
Jonah Kruger is a doctor who lives and works in Jerusalem. He studied medicine at McMaster University in Canada and completed his specialty training in pediatrics at Hadassah Medical Center, Mount Scopus. He treats children and adults privately for ADHD at Jerusalem's Wolfson clinic (and a lot on ZOOM lately). He can be contacted at [email protected].
The decision to start a child on ADHD medications is never an easy one for a parent. Evidence that ADHD medications are safe and significantly improve the long term outlook are certainly reassuring that the decision is in the child’s best interest. Many parents, however, are rightly concerned by many issues that demand explanation prior to getting started. This post will review the five most important things to know before getting started.
One - It’s a process
There are many ADHD medications available on the market today. The doctor will make an initial recommendation based on the child’s age, symptoms and background medical information. Regardless of which medication is selected, parents need to understand that unlike other medications that are simply dosed by weight or age, the ideal dose of ADHD medications is very particular to the individual. The response to low, intermediate and high doses should be checked before settling on a final “most effective” dose. Side effects are common and need to be dealt with as well. Often multiple medications need to be tried until one that is adequate is found. In some cases second line medications need to be tried. This process requires regular, weekly follow up and a timeline of weeks to months is standard. For those who stick with the process, the majority will meet with success. So have patience and hang in there.
Two - Side effects can and should be dealt with
Dealing with side effects is an important part of managing ADHD medications. Unfortunately, side effects are to be expected in most cases. The good news is that they can often be circumvented as well. Many side effects will disappear after the first few weeks if the medication is taken consistently, so giving it some time is the best first step. If time does not solve the problem, then often adjusting the dose will help. Finally, switching to a different medication is always an option. The ultimate goal should be a medication that relieves the symptoms of ADHD without significant side effects.
Three - Go long
Current guidelines recommend using the longest acting medication possible. There are two main reasons for this. Firstly, longer acting medications have a more stable blood level during the day and as a result cause less side effects. Secondly, children who have ADHD tend to struggle throughout their day including at school, during social activities and at home. Longer acting medications provide good symptom control throughout the day and allow children to be at their best whatever they are doing.
Four - Start low and go slow
Once a medication has been selected, the patient should be started at the lowest available dose. Usually, it takes at least a full week on a particular dose to get an idea of how effective it is and which side effects persist.
Five - Expect the unexpected
ADHD is a chronic condition and for most children it will accompany them into their adulthood. As children continue to grow and advance through different life stages, the symptoms of ADHD and associated impairments will usually change. This means that the situation needs to be constantly monitored and the treatment continuously adjusted. As a rule, as children grow, they tend to need higher doses and transition to longer acting medications. Some children might see a waning of ADHD symptoms over time and can try periods off medications or lower doses. Side effects can appear that were not initially present and different medications might need to be tried. While ADHD medications are very safe, regular monitoring of weight, height, heart rate and blood pressure are important parts of good ADHD follow up care. Patients should see their ADHD doctor every six to twelve months for routine follow up.
The outlook today for ADHD patients is very positive. Patients should always benefit from a comprehensive approach to treatment that includes patient education, healthy lifestyle and behavioral interventions. ADHD medications are safe, effective and for many patients a game changer. They do, however demand quality follow up care in order to navigate around the side effects and maximize their benefits.