Tuning Medication
It is recommended that the management of medication should only be undertaken under the supervision of a specialist in either Child and Adolescent Psychiatry or a Paediatrics who has training in the use of such medication in children and adolescents. Such medication requires safe and careful administration and storage as it can be dangerous if taken in excess or by those for whom it is not prescribed.
Methylphenidate is regarded as the psycho stimulant of first choice with an anticipated positive response in at least two thirds of patients treated.
Dexamphetamine can be tried when the response to Methylphenidate is unsatisfactory or significant side effects occur, since individual response to psycho stimulant treatment is idiosyncratic and failure to respond to one drug does not imply that an alternative preparation will be ineffective.
The dosage is increased over a few days with regular review to determine the effective dose and make any necessary adjustments to the timing of the medication.
In most cases medication would be continued for seven days per week to obtain maximum benefit with respect to the significant behaviour control problems which occur at home and in the community as well as in school. Weekend or vacation drug holidays may be required however if there are serious concerns about growth.
Self–administration is not acceptable in school children. These are controlled drugs and their administration requires to be supervised with a contract being drawn up between school, parents and child.
Side Effects
Side effects such as lowered appetite are usually avoided by taking the medication with food and starting the dose gradually. Some irritability, tiredness or tearfulness, as a dose wears off, or staying up later usually pass after a few days.
Side effects may be confused with non-response, too low a dose or as a dose wears off. Side effects are generally mild, can be managed with adjustments of timing or dose and can be confirmed by interrupting medication. Less than 5% of children have side effects requiring discontinuation of treatment. Stimulants are not addictive when used for appropriate clinical treatment of ADHD. |