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Stimulants
The largest class of drugs for the treatment of ADHD is the stimulants, which work by arousing the parts of the brain that are responsible for organization and management. Specifically, they increase levels of the neurotransmitter dopamine. Neurotransmitters are chemicals in the brain that transmit nerve impulses.
Stimulant medications are the most effective type of drug at helping patients' focus, and 70 to 80 percent of patients with combined ADHD and inattentive ADHD are treated effectively with them, with the former having the most predictable response.
The stimulant drugs include the following:
- Methylphenidate (Ritalin, Methylin)
- Methylphenidate, intermediate-acting (Metadate CR, Metadate ER, Methylin ER)
- Methylphenidate, long-acting (Concerta, Ritalin LA, Ritalin SR)
- Dextroamphetamine (Dexedrine, Dextrostat)
- Dexmethylphenidate (Focalin)
- Amphetamine (Adderall)
- Amphetamine, extended release (Adderall XR)
Children who take a stimulant medication will usually see an effect on their symptoms--an improved ability to concentrate and less impulsivity--within an hour. The "regular" or short-acting versions of ADHD drugs typically have to be taken every three to four hours. Stimulants that are designated as "extended release," "controlled release," "intermediate-acting," or "long-acting" take longer to break down in the body, so a patient may take only one pill during the day to last six to 12 hours. Because each person's reaction to drugs is different, the dosage and scheduling of an ADHD medication must be adapted specifically for each patient.
As with all drugs, stimulants can have side effects, though they tend to happen early in treatment and are usually mild and short lived. They include:
- Insomnia
- Decreased appetite or weight loss
- Increased anxiety
- Jitteriness
- Headaches
- Stomach ache
A small number of sudden deaths and nonfatal heart attacks and strokes in people taking stimulants have raised concerns about the drugs, and people with heart problems and high blood pressure are cautioned about taking them. Parents will benefit by working with a doctor who has known a child for some time before prescribing ADHD medicine, and has knowledge of any structural heart abnormalities (such as heart murmurs). Conscientious doctors also will want to observe whether a child has an adverse response to medicine after it is introduced. It should be noted that millions of people take stimulants safely, and that the incidence of life-threatening adverse events is extremely small. Moreover, a causal relationship between the drugs and the adverse reactions has not been established.
A small percentage of children who take stimulants develop tics, which are involuntary movements of various muscles, usually in the face and hands.
Side effects can often be managed by changing dosages, adjusting the dosing schedule, or by switching to a long-acting version of the drug or a different medication altogether.
Some parents worry that children who take stimulant drugs may be at greater risk of becoming addicted to drugs in general. Although newspapers often run stories of, say, Ritalin abuse among college students, the fact is that studies have shown that stimulants do not cause a greater risk of drug abuse as children get older. In fact, the opposite appears to be true: Children who do not take medication for their ADHD symptoms have been shown to have a greater risk of developing a substance-abuse problem later in life as they try to self-medicate.
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