Attention Deficit Hyperactivity Disorder in Teens (cont.)

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What stimulant medications are available to treat ADHD in teens?

Several studies have clearly established that pharmacologic (drug) therapy for ADHD is superior to behavioral therapy or cognitive behavioral therapy alone. Combining medication and behavioral therapy is less likely to improve behavioral outcomes over medication alone unless patients are also experiencing anxiety or oppositional defiant disorder. The first category of therapeutic medications is chemically classified as "stimulants." Studies have established that 80% of patients with ADHD will have a positive response to their use and this therapy is generally well tolerated. Medications come in short- (three to four hour), medium- (five to six hour), and long- (eight to 10 hour) lasting formulations. The two most common medications are: 1) methylphenidate (for example, Ritalin, Concerta) and 2) amphetamine (for example, Adderall, Adderall XR, Vyvanse). Stimulant medications that are in liquid or in patch form (Quillivant-XR and Daytrana, respectively) are now available, allowing children who have difficulty swallowing pills to benefit from medication. Both the methylphenidate and amphetamine classes of stimulants are felt to positively affect the neurochemical transmitters of the brain that moderate attention, arousal, and impulse control.

What are the potential side effects of stimulant medications?

Side effects may include appetite suppression, irritability, inhibited personality, depression, and sleep issues. Rarely, patients may develop tics and very rarely patients develop hallucinations while taking stimulant medications. Studies show that short-term use of stimulants (up to three years) may contribute to a mild slowing of the rate of height acquisition; however, the ultimate acquired height when considering long-term use is not thought to be affected. Recently, there have been concerns regarding the risk of sudden cardiac death in patients treated with stimulants. A recent policy statement from the American Academy of Pediatrics suggests that several elements be evaluated prior to initiating therapy with stimulant medications.

  1. Patient and family cardiac history of structural or functional heart disease, sudden death, unexplained death in children through young adults, and history of hereditary heart disease (cardiomyopathy and/or long QT syndrome): Concerns of these issues warrant evaluation by a pediatric cardiologist.
  2. Routine EKG or echocardiogram studies are not thought to be necessary for most patients.
Medically Reviewed by a Doctor on 5/7/2014