Understanding ADHD in Children and Adolescents
Attention Deficit Hyperactivity Disorder (ADHD) affects approximately 5–10% of children in Australia and similar rates are observed in Southeast Asian countries like Singapore and Malaysia. This neurodevelopmental condition often manifests as inattention, hyperactivity, or impulsivity, impacting academic performance and daily activities. While medication isn’t always necessary—especially for mild cases—pharmacological management is frequently recommended for moderate to severe symptoms causing functional impairment.
First-Line Treatments: Stimulants
Stimulants remain the gold standard for most children with ADHD due to their high efficacy (benefiting 80% of cases). Common options include methylphenidate (e.g., Ritalin) and dexamfetamine (e.g., Vyvanse). These medications enhance dopamine and norepinephrine activity in the brain, improving focus and impulse control.
Methylphenidate: Forms and Dosing
Methylphenidate comes in short-acting and long-acting formulations. Short-acting versions require multiple daily doses, while long-acting options like Concerta provide extended coverage. Starting doses are typically low and gradually increased to minimize side effects like appetite suppression, which is common and can affect growth if not managed with proper nutrition.
Dexamfetamine: An Alternative with Unique Benefits
Dexamfetamine, available in short and long-acting forms, is equally effective as methylphenidate. It may suit children who experience better tolerability—key for those with sensitive systems. Notably, long-acting dexamfetamine (lisdexamfetamine) offers convenience with once-daily dosing, ideal for school days.
Non-Stimulant Alternatives
For children who cannot tolerate stimulants, non-stimulant medications like atomoxetine (Strattera), clonidine, or guanfacine (Intuniv) are alternatives. These target norepinephrine pathways and are less likely to suppress appetite. However, their effect sizes are smaller compared to stimulants, making them often a second-line choice or adjunct therapy.
When to Use Non-Stimulants
Non-stimulants may be preferred in cases of stimulant intolerance, severe anxiety, or comorbid tic disorders. Atomoxetine, for instance, can reduce tics and anxiety, while clonidine and guanfacine provide direct calming effects.
Monitoring Safety and Side Effects
Regular health checks are crucial when children are on ADHD medication. Key parameters include:
- Cardiovascular checks: Measure heart rate and blood pressure every 6 months, especially for teens.
- Growth monitoring: Track height and weight, as appetite suppression may impact growth. Ensure balanced nutrition and snacks.
- Behavioral feedback: Schools and parents should collaborate to assess functional improvements or side effects like increased anxiety.
When to Consider Stopping Medication
Discontinuing medication isn’t automatic. If a child no longer requires treatment due to natural development or sustained control, a gradual taper may be considered. However, abrupt cessation is safe as there are no withdrawal symptoms. Parents should partner with healthcare providers to evaluate benefits versus side effects regularly.
Conclusion: A Collaborative Approach
Managing ADHD involves balancing medication efficacy with safety. In Australia and Southeast Asia, where access to specialists can be limited, GPs play a pivotal role in initiating and overseeing treatment. Open communication with healthcare teams ensures personalized care that adapts to a child’s evolving needs.
Medical Disclaimer:
This information is for educational purposes only and does not replace professional medical advice. Always consult a healthcare provider before starting, adjusting, or stopping medications. Individual responses to treatment vary.
