September 5, 2025

Should I Medicate My ADHD Child? Part 2

By: Dr. Renae Norton

In my last article on ADHD medications I talked about the problems inherent in using stimulants. In this article, we will discuss some of the side effects that ADHD medications in general can have. But let’s establish a few parameters first: To begin with, we know that medications do not work for all ADHD symptoms. We also know that medications do not affect everyone in the same way. Finally, there are other alternatives, I believe that we can use a combination of medications or supplements, behavior therapy and skills training to address most if not all of the ADHD symptoms. This is referred to as a multimodal approach. 

I am a systems based therapist. I look at casualty as being multiple and cyclical. By that I mean that it is a gross oversimplification to think that A causes B. If you think in linear terms such as that, you eliminate many other possible solutions. Let’s take the common cold we used to think that a germ caused a cold. We now know that a germ in a receptive host, under the right circumstances, that repeats again, and again can result in the common cold. 

It is the same thing with ADHD. We do not know exactly what causes ADHD. But we do know that each child is unique, such that using the ‘One Size Fits All’  used by most practitioners is less likely to be effective. Treating ADHD with medication is such an approach. 

As I mentioned in my previous article, (Should I Medicate My ADHD Child Part 1) the medications most often used to treat ADHD are stimulants, non-stimulants and antidepressants. Let’s take a look at how they work. 

STIMULANT ADHD MEDICATIONS

We are starting with the stimulants as they are the most popular…These drugs are believed to increase the levels of neurotransmitters in the brain that can improve focus. The problem as we saw in the first article is that they also come with many side effects. Nonetheless, the FDA has approved dozens of brand-name stimulants for ADHD (Of course they have). Although this sounds like a multimodal approach, the reality is that all of these medications contain versions of only two different stimulants; methylphenidate and amphetamine. 

Both of these drugs are dangerous, as evidenced by the fact that, Doctors don’t generally prescribe them for people with:

  • Heart defects or heart disease
  • High blood pressure
  • Hyperthyroidism
  • Glaucoma
  • High levels of anxiety
  • A history of drug abuse

There are two kinds of stimulants: short-acting (immediate-release) and intermediate or long-acting (extended release). 

The short acting stimulants usually begin working within 30-45 minutes of taking them and can last about 3-4 hours. You often take them two or three times a day. Although the amphetamines may be a little stronger than methylphenidate, and their effects may last a little longer, in general, both medicines are very similar. 

Some examples of each kind of short-acting stimulant include: 

  • Amphetamine: Adderall, Dexedrine, Evekeo, Zenzedi
  • Methylphenidate: Ritalin, and Focalin

Intermediate and long-acting stimulants can last 6-8 hours, while long-acting stimulants can last 8-12 hours and sometimes up to 16 hours. You usually take these once a day although I have found in my practice that not understanding how long they last, people often take them more than once a day, and then are unable to sleep at night. A commonly held belief is that long-lasting medicines are usually the best option because people with ADHD may have trouble remembering to take their medicine. I think the upshot of this is that they end up overmedicating and not getting the rest that is necessary for good concentration. 

Examples of each intermediate, and long-acting stimulant include:

  • Amphethamine: Adderall XR, Vyvanse, Dexedrine Spansule, Dynavel XR, Adzenys XR-ODTC
  • Methylphenidate: Concerta, Metadate CD, Ritalin-LA, Aptensio-XR, And Focalin XR

The problem with these stimulant medications is that they have significant side effects, which include: 

  • Loss of appetite
  • Upset stomach
  • Feeling restless or jittery
  • Racing heartbeat
  • Trouble sleeping
  • Irritability or mood swings
  • Headaches
  • Dizziness
  • Depression
  • Tics

Long-acting medicines may have greater effects on appetite and sleep than short and intermediate-acting stimulants. Stimulants may also raise your blood pressure and heart rate. But if that is not scary enough, there are some other safety concerns when it comes to stimulants. Experts in the field, have pointed out that:

  • We do not yet know what the long term effects on people whose brains are still developing will be. 
  • [Risk of sudden death in people with heart conditions is higher] The American Heart Association recommends that all people, including children, have their heart evaluated before starting stimulants. I can tell you from my experience that this rarely happens. 
  • [Increased risk for other psychiatrist problems] Some people may have personality changes on stimulant medicines. For instance, stimulants may trigger or make worse symptoms of hostility, aggression,anxiety, depression or paranoia. People who have a personal or family history of suicide, depression, or bipolar disorder may be at higher risk of this than other people and will likely be followed closely by their doctor while theyre taking stimulants
  • As mentioned above many people on stimulant medication suffer from anodontia or less loss of joy. 
  • Finally the potential for abuse is significant. A growing problem in schools and colleges is that teens and college students may abuse stimulants when they study for exams or when they want to lose weight. Kids with prescriptions may share or sell their stimulant medicine to classmates. It is next to impossible to ensure that your child is taking their medicine and not sharing or selling it. 

Stay tuned for the next article in this series, which covers alternatives to medications for ADHD.