ADHD Medication Treatment

Q: My son is 13 and was just diagnosed with attention deficit disorder with hyperactivity. How long will it take for the medication to get to a therapeutic level?

A: It is possible that all of your child’s behavioral problems may not be controlled by medication, especially since other factors may be involved. However, once the appropriate dose and type of medication is eventually reached, children with ADHD may have a noticeable response within 30-60 minutes of taking their prescription. But here’s an important caveat: Each and every response time is different, and your child’s physician may have a distinctive approach towards medical management of ADHD.

That said, we usually begin with a low dose of a particular medication (often a short-acting stimulant that we later convert to a longer acting preparation, but this varies) and re-evaluate for ADHD symptom improvement every three to seven days. If satisfactory results are not achieved, we may need to increase the dose of the medication over these same time intervals, until significant improvement is achieved. If a non-stimulant medication is utilized, the true response may not be known for several weeks until the correct dosage is reached. Whichever approach is used, most children (70-90%) will find that one medication or a combination of medications will work well to alleviate many of their ADHD symptoms.

In evaluating your child’s response to treatment, the physician will keep track of the following:

• The type of medication (stimulant vs. non-stimulant, others)
• Dosage (medications have a dosing range and one person may require more than another)
• Successful adherence to the prescribed medication schedule (how many times per day does it need to be given, are they able to remember to take it?)
• Contributing conditions that may impact the response to treatment. These include but aren’t limited to: depression, anxiety, oppositional defiant disorder (non-compliant with medications, behavioral approaches, outbursts of temper, etc.), learning disorder (dyslexia), hearing, vision or speech concern, anemia (low blood count), lead exposure
• Side effects such as weight loss, tics (clearing the throat, excessive eye blinking, others), sweating, dry mouth, sleeplessness and irritability (all may limit the dosage)

Depending upon the results, another medication (short acting, longer acting, different medication category) may need to be considered.

In the meantime, it is also important for your child to continue behavioral therapy that incorporates positive feedback for good behaviors and consequences for bad behaviors. Essentially, this approach helps children with ADHD learn a different way of reacting to stimuli (staying calm, not blurting out, etc.), as well as techniques to help them focus and retain information while at school. Behavioral therapy may also help to improve their ability to socialize and interact with others. Additionally, a structured environment (same routine for everyday living such as meal time, washing and brushing teeth, putting away dirty clothes, locating books, shoes, and organizing homework) is very helpful and would complement the medical treatment approach.

Lastly, it is important to utilize a team approach to maximize the assistance for your child. This includes behavioral questionnaires filled out by his teachers, other adult supervisors and yourself, as well as evaluations by a mental health professional and personal physician.

For further information, please visit the National Institute of Mental Health (www.nimh.nih.gov) and the National Resource Center on ADHD (www.help4adhd.org) as well as the American Academy of Child and Adolescent Psychiatry (www.aaap.org) and the Parents Medication Guide (www.parentsmedguide.org).

More ADHD Advice From Dr. Rob:

• Treating ADHD Without Medication
• ADHD and Your Child
• A Natural Approach to Gaining Better Focus
• Find all articles by Dr. Rob

Read More About ADHD: 5 Foods to Feed Your Child With ADHD 5 Foods to Avoid TV and ADHD: Is There a Causal Link? Popular Slide Shows on MSN Health & Fitness: 9 Ways to Make Your Kids Smarter 11 Brain Boosters 10 Foods Tough to Digest

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)