Stimulant medication for hyperkinetic disorder and
attention-deficit hyperactivity disorder: for parents, carers and
anyone who works with young people
About this factsheet
This is one in a series of factsheets for parents, teachers
and young people entitled Mental Health and Growing Up.
The aims of these factsheets are to provide practical, up-to-date
information about mental health problems (emotional, behavioural
and psychiatric disorders) that can affect children and young
people. This factsheet describes what stimulant medications are,
and the benefits and pitfalls of using them for attention-deficit
hyperactivity disorder (ADHD) and hyperkinetic disorder.
Introduction
What are stimulant medications?
They are medications that affect the action of certain
chemicals in the brain. In adults, they have the effect of making
people more alert, active and awake. This is why they are called
stimulants. In children, they can increase attention and reduce
hyperactivity, and are used as one part of the treatment for
hyperkinetic disorder and attention-deficit hyperactivity disorder
(ADHD) (see
Factsheet 5 on ADHD and
hyperkinetic disorder).
When is medication used?
Medication should be prescribed only after your child has been
fully assessed by a specialist. Stimulant medications may be worth
trying if your child has serious difficulties with:
- concentration - can't concentrate for very long, doesn't seem
to listen, is forgetful, disorganised, takes ages to start things
and then rarely finishes them, is easily distracted
- activity levels - is overactive, climbs on things all the time,
talks all the time, is very loud and noisy
- impulsivity - can't wait for things, interrupts a lot, acts
without thinking.
They may have big problems:
- at school - poor concentration, can't complete a task,
disruptive in class
- at home - on the go all the time, can't follow instructions,
poor concentration, forgetful
- with friends - difficulty taking turns or sharing, getting into
fights.
How stimulant medication works
Stimulants seem to affect parts of the brain that allow us to
control how we pay attention and organise our behaviour.
What are its effects?
The child's behaviour becomes calmer, more focused and less
impulsive. However, medication does not work for everyone. It is
also important that the child has adequate help with learning in
the classroom, and with controlling behaviour (see
Factsheet 5 on ADHD and hyperkinetic
disorder).
Why does medication help?
Stimulant medication creates a `window of opportunity' when
children can be focused and concentrate better. They can therefore
learn better at school. Some children say that when they are taking
the medication, they can think more clearly, and find it easier to
understand requests from parents and teachers. School work becomes
more interesting and enjoyable, and they make more friends.
Parents and teachers can do a lot to help a child to make
these changes. Your understanding and support (practical and
emotional) are crucial. Practical and effective ways of helping a
child to improve behaviour include:
- praising good behaviour
- making clear simple requests - one at a time
- praise for effort as well as achievement
- rewards for good behaviour
- brief periods of time away from other people when their
behaviour becomes too much.
Which stimulant medications are used?
The stimulant medication most commonly used in the UK is
methylphenidate. When it works, the effect begins within
30 - 60 minutes. The exact amount of each dose needs to be
carefully monitored and adjusted by a specialist. There are also
long-acting forms that last up to 12 hours.
Dexamphetamine is a stimulant that is chemically very
similar to methylphenidate. It sometimes works when methylphenidate
does not.
What are the side-effects?
As with any effective treatment, there might be side-effects,
such as reduced appetite and staying awake later than usual.
Side-effects are less likely if the dose is increased gradually
when the tablets are started. Some parents worry about addiction,
but there is no good evidence to suggest that this is a
problem.
The most common side-effects are:
- reduced appetite
- staying awake later.
Because of the effect on appetite, the child's height and
weight should be measured regularly. Giving medication with meals
may help.
Less common side-effects to look out for include:
- being `over-focused', quiet and staring _ this may be a sign
that the dose is too high
- anxiety, nervousness, irritability or tearfulness
- tummy pains or feeling sick
- headache, dizziness or drowsiness
- tics or twitches.
How long should the medication continue?
Medication may need to be continued for several years. Some
children will be able to stop completely as teenagers, others may
be able to stop even sooner. Some may still need medication as
adults. There are no known harmful effects from using these
medications over several years.
Treatment will be monitored by a specialist and will be
reviewed regularly. Medication may need to be adjusted. Physical
health checks and repeat prescriptions may be provided by your
general practitioner.
Non-stimulant medication
If stimulants don't work, your specialist may suggest one of a
number of alternatives, such as imipramine or clonidine.
References
- Carr, A. (ed.) (2000) 'What Works with Children and
Adolescents?' - A Critical Review of Psychological Interventions
with Children, Adolescents and their Families. London:
Brunner-Routledge.
- National Institute for Clinical Excellence (2002) 'Guidance
on Methylphenidate' (Ritalin/Equasym) - for Attention Deficit
Hyperactivity Disorder (ADHD). www.nice.org.uk
- Rutter, M. & Taylor, E. (eds) (2002) 'Child and
Adolescent Psychiatry' (4th edn). London: Blackwell.
- Scott, A., Shaw, M. & Joughin, C. (2001) 'Finding the
Evidence' - A Gateway to the Literature in Child and Adolescent
Mental Health (2nd edn). London: Gaskell.
Sources of further information
Provides information and resources about
Attention Deficit Hyperactivity Disorder to anyone who needs
assistance.
- The Mental Health and Growing Up series contains 36
factsheets on a range of common mental health problems. To order
the pack, contact Book Sales at the Royal College of Psychiatrists,
17 Belgrave Square, London SW1X 8PG; tel: 020 7235 2351, ext. 146;
fax: 020 7245 1231; e-mail: booksales@rcpsych.ac.uk, or
you can download them from this website.
© [2004]
Royal College of Psychiatrists. This factsheet may be downloaded,
printed out, photocopied and distributed free of charge as long as
the Royal College of Psychiatrists is properly credited and no
profit is gained from its use. Permission to reproduce it in any
other way must be obtained from the Head of Publications. The College
does not allow reposting of its factsheets on other sites, but
allows them to be linked to directly.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
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