The study included data from randomized controlled trials involving more than 12, children or adolescents. The studies were conducted mainly in the US, Canada and Europe, included males and females aged , and all compared methylphenidate with either a dummy pill or no intervention. Methylphenidate was found to cause modest improvements in ADHD symptoms, general behavior and quality of life. There was strong evidence that methylphenidate improved teacher-rated behavior. Analysis of adverse effects showed that children were more likely to experience sleep problems and loss of appetite while taking methylphenidate.
Learn more about ADHD. Weaknesses of the trials that were reviewed included the fact that the people involved could have been aware of which treatment the children were taking. There was also incomplete reporting of results in many cases, and for some analyses, there was variation among trial results.
Based upon this information, the researchers urge clinicians to be cautious in prescribing methylphenidate and to weigh up the benefits and risks more carefully.
In Prof. Coauthor Dr. Camilla Groth points to a lack of clarity about who the drug will benefit and the poor quality of the evidence. She calls for this to be taken into consideration when prescribing methylphenidate. She recommends that doctors balance the pros and cons of prescribing it, and wants treatment to be monitored carefully. Our expectations of this treatment are probably greater than they should be, and whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence.
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What we still need are large, well-conducted trials in order to clarify the risks versus the benefits for this widely used treatment. In our survey, parents of children who tried medication reported positive changes within a few days of starting amphetamines or methylphenidates. Second-line medications Strattera took longer to work, but most parents noticed positive changes within a few weeks. About 10 percent of the parents whose children tried amphetamines and methylphenidates said they didn't notice any positive changes. According to the parents we surveyed, children on medication had slightly better outcomes than those who weren't.
And while medication was cited as the strategy most helpful in managing ADHD see ADHD treatments that work , parents were not very satisfied with it overall. In fact, only 52 percent of the parents agreed strongly that if they had to do it over again, they would have their kids take medication, and 44 percent wished there was another way to help their child. See Parent satisfaction with medication below.
Medication helped more in some areas than others. Parents in our survey said medication helped equally—and most of all—with academic performance very helpful for 35 percent and behavior at school very helpful for 35 percent. It also helped well with behavior at home very helpful for 26 percent , and fairly well with social relationships very helpful for 19 percent and self-esteem very helpful for 18 percent.
Furthermore, the degree of helpfulness with academic performance, behavior at school, and behavior at home most likely accounted for how helpful the parents rated medication as a specific strategy. Medication seems to lessen some ADHD symptoms, but behavioral strategies can help manage the condition for the long-term.
Children taking either stimulants or nonstimulants who started off with serious symptoms showed the most change, with a greater likelihood of improvement. Kids whose symptoms started off mild also improved, but the difference wasn't as great. Amphetamines and methylphenidates were equally associated with symptom changes in all areas See more about ADHD symptoms. Most children in our survey who were taking medication for ADHD had tried methylphenidate 84 percent or an amphetamine 51 percent in the past three years.
A smaller percentage 17 percent had tried a nonstimulant medication. There were no differences in the type of medication children were prescribed either by age or length of time since they had been diagnosed. Most children taking these medications had been taking them for longer than two years 35 percent overall , while 22 percent had been taking them for one to two years.
Our survey found there were no major differences in effectiveness between amphetamines and methylphenidates. Here's how the children fared with medication in these specific areas:. We asked parents to rate how helpful each medication was in the following areas: academic performance, behavior at school, behavior at home, self-esteem, and social relationships. Both amphetamines and methylphenidates were equally likely to be helpful in all areas with the exception of behavior at school, where amphetamines were rated as slightly more helpful.
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Although we don't have enough cases of children taking "second line" medications e. Straterra to report specific findings, the data we have indicates that they were generally less likely to be "very helpful" than amphetamines or methylphenidates in the areas we asked about. If a child is struggling in the areas of self-esteem and relationships, and medication is not helpful, it might be useful to have him or her see a clinical psychologist or other mental-health professional.
Whenever the result of taking a drug is less than desired, it might be time to consider changing medication, Goldstein suggests. Some children experience different effects from a different formulation of the same medication. A vast majority of children in our survey received medication from a pediatrician 60 percent , followed by a child psychiatrist 18 percent and a general psychiatrist 15 percent. All of the drugs carry a warning about rare cases of sudden, unexplained death. It is recommended practice to test for life-threatening conditions, including heart-related issues, before prescribing these medications.
Overall, physicians did a decent job of screening before prescribing medication.
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Eighty-five percent of the children we surveyed received some sort of screening, and 76 percent were given a general medical exam. It should be checked before starting medication, and at least once while the child is taking medication. And even though 85 percent of the children were screened before starting medication, 15 percent did not receive any type of screening. A parent should always request basic screening of their child before starting medication for ADHD. We also asked parents about other things they wished their prescribing physician had done.
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Parents didn't rate doctors well for managing their child's medication. He offers these additional tips:. Always call the doctor with questions. Even if all is well, check in by phone two weeks after beginning medication and schedule a visit one month after for a follow-up.
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After that, return visits will depend on the success of the treatment and side effects. In general, children doing well can be seen every six months. Reassessment should consist of a physical examination and direct questioning of the child and family member s. Teacher evaluations are also helpful. A complete re-evaluation with the family and input from others including teachers should be considered every year, although waiting two to three years is common. Side effects are a major area of concern for many parents considering medication for their child's ADHD.
Indeed, side effects might add to the overall stress of managing a child's condition. These medications can be stopped at any time. However, ADHD is a chronic condition. Its severity and developmental course are quite variable in duration and severity. Up to 60 percent of children with ADHD continue to exhibit problematic symptoms into adolescence and adulthood. For these individuals, continuing effective treatment modalities, including medication, can be helpful.
This should be decided with the prescribing medical professional and the therapeutic team. Children can often benefit from medication outside of school because it can help them succeed in social settings, peer relations, home environment and with homework. Medication can be of help to children who participate in organized sports and activities that require sustained attention, such as musical programs, debate or public speaking activities.
ADHD: Symptoms, Causes and Treatment
What about individuals who do not respond to medication, either psychostimulants or antidepressants? In general, two or three different stimulant medications should be tried before determining that this group of medications is not helpful. Similarly, several different antidepressant medications can also be tried. Most individuals will respond positively to one of these medication regimens. Some individuals, because of the severity of their disability or the presence of other conditions, will not respond.
And some individuals will exhibit adverse side effects.
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In such cases, the entire treatment team—family, physician, mental health professional and educators—must work together to develop an effective intervention plan. Other medications such as clonidine may be helpful, and occasionally, combinations of medication may be needed. When all medication appears to be ineffective, consideration needs to be given to whether the diagnosis of ADHD is accurate, whether other conditions are affecting functioning, whether appropriate criteria for improvement have been established, and whether objective and accurate feedback is being provided regarding the effectiveness of medication.
Are children who take psychostimulant medications more likely to have substance abuse problems later in life? Multiple studies that have followed children with ADHD for 10 years or more support the conclusion that the clinical use of stimulant medications does not increase the risk of later substance abuse. In fact, many studies have shown that individuals with ADHD who are not effectively treated with medication during childhood and adolescence have an increased risk of developing significant alcohol or drug abuse problems later in life.