ADHD Meds for a Child

June 19, 2008 6:18 PM

Choosing between ADHD meds for a child.

Have you given your child ADHD drugs? I need to choose between Concerta, Vyvanse, Strattera and Focalin XR. The child is nine. What side effects have you experienced when giving (any of) these drugs to your child, and what would you advise against or for? The need is without doubt. The question is which to choose between the 4. I saw previous questions but they weren't geared toward kids.

If you'd rather send an email, I set one up adhdkidstuff [at) gmail.

posted by anonymous to health & fitness (24 comments total)

My God, ethics of medicating ADHD-positive children aside, why are you asking us this and not a licensed psychiatrist? If your psychiatrist does not have the experience to give you anecdotes and his or her view on the pros and cons of each drug, then you need to find one more experienced in these issues. They do exist!

This is your child, for Chrissake, and you are preparing to give them serious, no joke drugs. Why wouldn't you go to a qualified professional?
posted by schroedinger at 6:34 PM on June 19, 2008 [2 favorites has favorites]

The child of an acquaintance of mine was diagnosed with ADD and after they worked with the doctor to select medication, the child had a terrible reaction to it - aggressive, sick, etc. Then they tried another - speedy, couldn't sleep. Then the third after two days worked like a charm (and isn't in your list).

My adult ADD friends have related similar stories to me. That finding the perfect med is great, but it's trial and error and the reason they have so many is that everyone reacts differently and there are no good predictors. Even which side effects will crop up is a crap shoot.

So, whatever you choose, hold tight and don't count on the kid being miraculously changed overnight.
posted by Gucky at 6:40 PM on June 19, 2008

I know you say there is no doubt of the need for giving your child drugs, but if you have to come to the internet to ask about possible side-effects, maybe you haven't received enough good advice from your doctors. Before putting your child (yourself, or anyone) on mind and mood-altering drugs, try "cavemanning" his diet. That is, take away processed foods, chemical dyes, high fructose corn syrup, artificial preservatives, and all of that nasty stuff. My mom has been an elementary school teacher for decades now, and she has seen first-hand how much better a lot of her ADD kids perform when their diets change relative to their classmates put on drugs.
posted by phunniemee at 6:51 PM on June 19, 2008 [1 favorite has favorites]

I was a kid with ADD (his age, through the middle of highschool) who took Ritalin, Concerta, Strattera, and Adderall (though not at the same time). I am now a university student with ADD who takes a low dose of Concerta. I have no medical background, this is not medical advice.

Vyvanse, Concerta, and Focalin are all stimulants. Concerta is simply the time release version of Ritalin, and I preferred it over the straight version. Stimulants mean he could have issues with diet, growth, tics, etc, Personally, these drugs made me crack my knuckles and tap my fingers incessantly. I was a very skinny kid because I rarely had the desire to eat. You need to find a dosage balance between side effects (if any) and the degree to which they aid focus. You can go on and off these drugs as you like without issue (though if you go up to a high dose from nothing you can feel a bit strung out). My doctor had no problem with me going off the medication on weekends or during the summer if I chose to do so.

What does it feel like to be on them? Excellent focus. Really makes a difference if you get the dosage right. One downside is that if you don't eat before or soon after taking them you can feel very jittery and strung out. With the time release version, you need to make sure you're eating regularly. Essentially, you don't want the drugs in your stomach alone, as they're absorbed too quickly.

I have nothing postitive to say about Strattera or other drugs of it's class (NRIs). You cannot go on and off them at will, there are terrible side effects. When you are prescribed them you will be given a series of pills to "ramp up" your dosage. My understanding is that they alter brain chemistry in a much slower an pervasive way (read the wiki page). I had extreme paranoia, anorgasmia, and depression going on and off these drugs. This is likely a matter of individual brain chemistry, but I would not give them to a child.

Give your son a choice in this. If he doesn't like how the drugs make him feel, let him stop. Make it clear that you don't feel anything is wrong with him as is (and make sure that's actually the case).

I still grapple with the philosophical issues of taking these drugs. Am I cheating? Is the way my mind works naturally inferior? Why are these drugs okay for me but not others? How different am I on the drugs, how am I modifying my personality? Is being high all the time ethical? Does this "condition" even exist? Why do we pathologize this... isn't it simply on the spectrum of human experience? Do they even have a neurological explanation for this condition? I could write a book.

I think this distractable tendency leads me to think in different and often positive ways. I think it makes you more creative, more likely to see certain connections, to be curious - but it's hard to see where biological determinism ends and quirks of personality begin. It can also be incredibly, crushingly, frustrating to do the things you want to do.

I don't take this lightly, and neither should you. The drugs can make a huge positive difference in one's life, but that's a strange reality to live with.

The drugs alone are not going to change his life. He'll need to be organized, he'll need to have systems, he'll still need to cope with the way he works. Keep in mind, he is 9 years old. He doesn't need to be all that on the ball for at least a decade.
posted by phrontist at 6:52 PM on June 19, 2008 [10 favorites has favorites]

Oh, and for the record, the ADD-diet link is not, to my knowledge, supported by any credible research.
posted by phrontist at 6:54 PM on June 19, 2008 [2 favorites has favorites]

Oh, and for the record, the ADD-diet link is not, to my knowledge, supported by any credible research.

When the alternative is serious drugs for an indefinite amount of time, what could it possibly hurt to try?
posted by phunniemee at 6:58 PM on June 19, 2008

I'm just saying, it's a shot in the dark. It's never a bad idea to eat healthily, but I wouldn't change his whole diet (and exclude a lot of things, which is difficult for a kid) when there is no justification.
posted by phrontist at 7:01 PM on June 19, 2008

That is, take away processed foods, chemical dyes, high fructose corn syrup, artificial preservatives, and all of that nasty stuff. My mom has been an elementary school teacher for decades now, and she has seen first-hand how much better a lot of her ADD kids perform when their diets change relative to their classmates put on drugs.

Those diets are really really hard to stick to. I think it would be even harder for children, sense they tend to lack self-discipline more than adults.

I think adding foods is easier to stick by. Foods high in Omega 3 fatty acids, high in protein and complex carbs, and a good multivitamin should help. Vitamin and mineral deficiencies can make symptoms worse, hypoglycemia can too. There's a lot of information on Omega 3 Fatty acids out there. Do a google search.

As for meds, when I took them as a teen, I preferred the quick release ritalin and adderall, opposed to the slower acting forms of the medications. The pills took away my appetite, interfered with my sleep, and made me extra nervous. I only took them during school hours, and was glad when the meds wore off in the evening.
posted by sixcolors at 7:16 PM on June 19, 2008 [1 favorite has favorites]

Vyvanse, Concerta, and Focalin are all stimulants. Concerta is simply the time release version of Ritalin

Uh, Ritalin is a strong stimulant. Please no bad info.
posted by Justinian at 7:40 PM on June 19, 2008

Lot of finger wagging in this thread already... anonymous didn't ask for diagnosis help, she asked for experiences with the various drugs.

I was (finally) diagnosed with ADHD after suffering 30+ years with it. School was terrible for me- maybe I benefited somehow from never being able to finish my homework and being unable to keep a neat desk and the like, but I sure don't see it.

Yes, stimulants are "serious" drugs. Just like caffeine. But pharmaceutical stimulants at the correct doses are many orders of different from meth and MDMA. There's a reason ADHD people benefit from these drugs; it is that they are lacking something in their brains that the stimulant makes up for. Properly used, they don't "drug up" the kid or "mask" anything. They simply allow a user's brain to function in a more ordered manner. When they are used to bring potential up to 100%, that is a correct use. When they are used to somehow trick nature and try to get beyond 100%, that's abuse. It's a huge difference.

Educating you kid about the drug is important, however. Make sure he understands the difference between therapeutic use and recreational abuse.

So, I've only had experience with Adderall XR and Vyvanse. (Rhymes with Vivian Vance!) Both are amphetamines. Adderall is a mixture of a number of different types, in a times release formula- one XR has the effect of taking the two or three regular ones throughout the day. The effect being that each type of amphetamine Vyvanse is a prodrug- a substance that only turns into amphetamine as it is metabolized in the body.

I found the Vyvanse to be better for me- it seemed to be a little "cleaner", where the Adderall had some "speedy" side effects. The physical ones, I mean. If I accidentally drank more than a couple of servings of coffee, I would be twitchy and sweaty. I also found that the Adderall had more of an appetite suppression effect (and subsequent late night insatiable hunger from not having eaten all day). Vyvanse didn't do that. I also found that Vyvanse lasts longer, but not in a bad way. I can be my productive self all day, and then in the evening when its time for bed, I go to sleep. (Doses were 15mg of Adderall and 40 of Vyvanse- supposedly equivalent) Also, note that these drugs were designed to give a person a day's worth in one shot. Forgetting to take it first thing in the morning and then taking one later in the day will result in not sleeping well until it wears off.

If I were in your situation, I would insist on going it slow and titrating to the lowest effective dose. While these drugs restore the ability to do things, developing good study and life management habits alongside that is just as important. They are "magic pills" in that they instantly change ones ability to focus, but they ARE NOT magic pills when it comes to what you do with that newfound ability. If I don't make a point to direct myself and make good choices, all the pills do for me is make me a more effective slacker.

Also, I didn't notice ANY personality changes or the so-called doping up effects. I am as creative as I ever was- maybe even moreso because I have more time in the day to work on creative things because it doesn't take me three hours to do the dishes, etc.

I wish I had been diagnosed and treated as a youth- it's been a lot of hard work digging out of a lot of bad habits. Good luck, and don't let the naysayers mess with your head. The worst that can happen is the drugs don't work and you find out that ADD wasn't an incorrect diagnosis. The results are pretty instantaneous.
posted by gjc at 7:47 PM on June 19, 2008 [1 favorite has favorites]

Uh, Ritalin is a strong stimulant. Please no bad info.

Actually, phrontist is correct. Concerta is the slow-release version of Ritalin. Ask your doctor, but I trust mine.
posted by InsanePenguin at 7:48 PM on June 19, 2008 [1 favorite has favorites]

Forgot to mention- one issue might be that a younger person will find it harder than I did to deal with the changes the drug will effect- make sure you talk with him and give him expectations as to what will happen. It was refreshing for me, it might be scarier for a kid.
posted by gjc at 7:50 PM on June 19, 2008

Actually, phrontist is correct. Concerta is the slow-release version of Ritalin. Ask your doctor, but I trust mine.

You guys are both confused. Whether it is slow-release or not has no bearing on whether it is a stimulant. For example: Adderall XR is the time-release version of Adderall, but I assure you that Adderall (a mix of amphetamine salts) is a stimulant. Similarly, Ritalin is a stimulant (Methylphenidate) in both the immediate and time-release version.

Seriously, if there is one place to try to avoid inaccurate information it is in medicine threads.

OP: Ask your doctor about these medications. He or she will have the best information for you. I assure you that if somebody doesn't know whether or not Ritalin is a stimulant you should not be accepting medical information from them.
posted by Justinian at 7:56 PM on June 19, 2008

Justinian, who said it wasn't a stimulant? Reread the comment that you are supposedly correcting. Everyone agrees that Concerta and Ritalin are stimulants:

Vyvanse, Concerta, and Focalin are all stimulants. Concerta is simply the time release version of Ritalin.
posted by alms at 9:02 PM on June 19, 2008

When the alternative is serious drugs for an indefinite amount of time, what could it possibly hurt to try?

My parents tried everything else, before meds. As a result, for years I couldn't make friends, couldn't concentrate in school, was ostracized, and felt crazy. Everyone was angry with me pretty much all of the time and I didn't know why. The long shot is I can barely remember my childhood.

I started taking meds in my mid-teens and it was like flipping a switch. Suddenly, I could observe the world around me, so I could start learning the social skills that everyone else just got.

I know that medications are the root of all evil, but you know? Sometimes they're not.

I can totally imagine that anonymous went to a psychiatrist, who gave the standard "This drug may have this side effect, this other drug is better for xyz" and now the poster wants to hear personal stories that s/he can relate to. And truthfully, despite much hand-wringing, if you give a child the wrong medicine they will have a bad reaction but they won't die or go permanently nuts. You can tell almost right away which meds are better and which are worse. The real drag is because these are all really, really controlled substances, your psychiatrist will probably not be able to offer you free samples to figure out which one will work. And Concerta *is* expensive (but totally, totally worth when it's the right prescription).

Personally, I'd recommend a slow release. I tried both Dexedrine (another slow release, stimulant form of Ritalin) and Concerta. I haven't heard of many people using Dexedrine lately so I assume that it's gone out of style now that Concerta is available. I personally like Concerta a lot.

The best thing is you just give your kid the pill at the beginning of the day and that basically takes care of their medicine for the day. Psychiatrists will tell you that it leaves the body after 8 hours. I can tell you that I still feel the effects later than that; perhaps this is just psychosomatic or something, but nonetheless I don't think you'll need a second pill for the evening; that first pill sort of "resets" my brain so that I generally have my mind in a good state for the rest of the day after the drug has worn off.

Appetite suppression is a definite problem with any of these drugs. I noticed that I was not actually less hungry, but simply forgot to eat. Make sure that your kid has a nice healthy lunch packed every day and eats during recess, and weight loss shouldn't be *too* bad (I lost around 10lbs initially but then slowly returned back to my normal weight [which was probably around 120-125lbs at that time]). She or he should have their appetite back around dinner time, so that is a good time to "catch up" on calories also.

Oh! The other reason I like Concerta is that, unlike other slow-release meds, it isn't a capsule with tiny grains in it. Those can be a pain and, if caught in the throat somehow, can dissolve and then you start coughing up little granules. Not fun. Concerta is very very tiny and goes down easily. The pills are very resiliant so there's no danger of them popping open and spilling all over the place either (this used to happen with the Dexedrine all the time).
posted by Deathalicious at 10:07 PM on June 19, 2008 [3 favorites has favorites]

Straterra put my son into deep, near suicidal depression. On the bright side, he actually did his homework for the first time in his life. Oddly enough, I decided the tradeoff wasn't worth it. In other fun Straterra news, it also causes liver damage and the FDA is considering taking it off the market.

Old fashioned Ritalin doesn't stay in the body as long as any of these newer drugs. For a while, my son was on that and it worked fairly well and I didn't feel like he was being drugged into oblivion. Haven't tried any of the others you mentioned.
posted by mygothlaundry at 10:08 PM on June 19, 2008

I'm not sure what Justinian is objecting to, but to be clear: Ritalin is a stimulant that comes in the form of a pill which dissolves fairly quickly on exposure to your stomach acids. Concerta is the same substance, but it's in a package that has a very small hole drilled in it with a laser, allowing the substance to enter your bloodstream steadily throughout the day.
posted by phrontist at 10:50 PM on June 19, 2008

I agree with everything gjc said.

Also, I didn't notice ANY personality changes or the so-called doping up effects. I am as creative as I ever was- maybe even moreso because I have more time in the day to work on creative things because it doesn't take me three hours to do the dishes, etc.

Just to be clear, I don't feel less creative, but the way I behave is altered. The way I think is noticeably altered.

A good example would be sitting in the library trying to do homework.

I start on a problem that involves simple harmonic motion with masses a springs, without the meds. I begin solving it with the general equation I've learned, and then my mind begins to wander... how can you come to this equation just knowing how hooke's law and newton's laws work. Interesting, looks like it's based on differential equations. Huh, that's an interesting connection to uniform circular motion. Next thing you know it's 4am, I haven't even done 3 of the 25 problems I have to do for this assignment and I've got to turn in to pass physics. It's frustrating.

With the medication, the ideas would still occur to me, but I can stop myself. It's hard to describe, but you just feel in control. I think it's a better way to live, but there is no denying it's a value judgment, and that's what I had difficulty coming to terms with. It's not like the pills make me a drugged up zombie, but they change the way I live, and that changes who I am. You could (and I do) say that of all decisions, but this is a particularly influential one, that's all.
posted by phrontist at 11:00 PM on June 19, 2008 [1 favorite has favorites]

I would advise that it is in the best interest of your son to FIND A DIFFERENT DOCTOR - a psychiatrist who specifically works with kids who have ADD and will take the time to get to know your son and use his or her own judgment and experience to decide which drug (if any) is best. Of course, your input is essential, as you're with your son all the time and you can see best how he's affected by the drugs on a daily basis, and a good doctor will work with you and take your input very seriously. A doctor who allows you to decide which drug you want, based on advice from non-medical professionals on the internet, is a quack or an idiot. These drugs are serious and not to be played around with.
posted by cilantro at 12:45 AM on June 20, 2008

To echo others (and as someone who was medicated for ADHD for over a decade), your psychiatrist should be answering this question. Also, keep in mind that there's nothing wrong with trying out a few different drugs to see which of the side effects are most tolerable.
posted by dondiego87 at 5:22 AM on June 20, 2008

Strattera is potentially interesting but I think it is frankly a bit too new. When you consider that it is a med given every single day for years on end you want to know that it is safe. Ritalin is not without issues, but they are already pretty well known and for most people well tolerated. Big breakfast, big dinner, lunch will probably not be eaten. The Concerta form I believe has the most constant release profile and thus avoids blood level spikes or dips.
posted by caddis at 6:27 AM on June 20, 2008

I am not a doctor, I am not your doctor.

That said, I have been treating my son with Ritalin in one form or another for nearly a decade.

It is exceedingly important to remember that the drugs are only a small part of the therapy. They can only do so much. This is important to bear in mind; I think many parents think of them as a panacea and they are not in the least.

You need to create structure in your child's life that they cannot provide for themselves. You will also need to make sure they eat enough, and that they get good nutrition. You will need to be on top of the side effects. It is exceedingly important that they take the medication on a rigorous schedule. You need to remind the child that the drugs do not make him good, they help him decide to be good.

You will also need to bear in mind that as the child grows, the dosage may need to be modified. It can take a few weeks or longer to get it right. You will need to establish good metrics so you know when this needs to occur and when it is right again.

My son has been on Concerta for the past few years. In my opinion, it is the best available.
The side effects have been minimal, and it lasts all day so only one dose is needed. Your mileage may vary, but I have been very happy with the Concerta.

The other drugs were either uneven in their effectiveness or harsh in their side effects.

If you live near the Madison, WI area, I cannot recommend Dr. Wendy Coleman strongly enough. She is a fantastic doctor and has been a tremendous help.


Good luck.
posted by Pogo_Fuzzybutt at 7:30 AM on June 20, 2008

I've only tried Adderall and Aderall XR so I can't answer your exact question, but I did want to offer a bit of advice. I found the XR version to not only be less effective, but to have much more intense side effects-- especially sleeplessness. It also made me nauseated, which the regular-release form did not. While I admit that the non-XR versions cause a sort of peak-and-fall effect (meaning that my day involves a whooosh...yay...crash kind of ride), I found that it's most manageable for me. (I also found that taking a combination of short-release and XR Adderall eliminated the crash, but I still don't do that regularly because of the sleeplessness.)

If you've ever taken any kind of psychoactive medication and compared experiences with other people, you probably know that everyone reacts to medications a little differently. You and your son may need to try several or even all of the available medications before you find the right fit. But keep looking for the right medication at the right dose-- as someone whose ADD wasn't diagnosed until my twenties, I have the utmost respect for what you're doing for your son, and I believe that it is wholly worthwhile.



(Aside:
It's really frustrating that almost all threads about ADD/ADHD, stimulant medications, and medicating children get derailed by sanctimonious wannabe-doctors. You all are entitled to your opinions, but when someone asks "Which of these four drugs should I choose," answering "NO DRUGS 4 LYFE!" is not helpful.)
posted by chickletworks at 10:36 AM on June 20, 2008 [2 favorites has favorites]

When my son was 6 he started on Ritalin. At that time he needed to take 3 pills a day, which was just plain inconvenient. I noticed that if he had the generic equivalent instead of the brand that he had a bad reaction, including wishing self-harm and hearing voices. We never figured out why. We tried Concerta for a while, but my son maxed out on the dose. Eventually my doctor suggested we try Adderall and that seemed to have a more consistent effect. For the last 2 or 3 years he's been taking Adderall XR in the morning plus a regular Adderall in the afternoon. Two months ago my doctor told us about Vyvanse which lasts for 12 hours and we've been really pleased with it so far. My son is now 13 and he likes taking one pill in the morning and being good for the whole day. He also sleeps better on Vyvanse, though he still takes Clonidine to help him fall asleep. The Vyvanse also seems to alleviate the mild anxiety he has better than the other drugs we've tried.

All of these changes have been made under the guidance of our pediatrician, who we see every three months for a med check, or more often if there is a problem. (We've seen him twice in the past 2 months plus talked on the phone in order for him to monitor the change to Vyvanse.) At times when he wasn't sure how to approach an issue he referred us to a Pediatric Psych Nurse who was invaluable in the process, especially with regards to his anxiety. She in turn referred me and my husband to a therapist to help us deal with the challenges of raising a child with severe ADHD, especially in the context of a new marriage/blended family situation. We even saw a cardiologist a few times to make sure the stimulants weren't causing any heart issues.

It is so important to have a proactive pediatrician. My stepson, for example, sees a pediatrician who kept him on the same dose of Concerta for 5 years and didn't do regular follow-ups. The poor kid was a space-shot in school but his mom felt like they were doing all they could for him because he trusted the doctor. When he started failing 10th grade we finally convinced her to take him to the same Psych Nurse my son had seen, and she straightened out his dose. He was also diagnosed with a learning disability (at 16!) that had gone unnoticed because his problems in school were attributed to his ADD. (My ped. on the other hand, told us from the get-go that ADD/HD is often co-morbid with LDs and urged us to have my son tested by the school dept.) The sad thing is that he's entering his Senior year in the fall and is really behind. It's like he missed a whole chunk of his education but he doesn't get a do-over. This experience has made me appreciate my pediatrician even more.

If your doctor has left it to you to choose what meds to give your child, you probably need a new doctor. As you can see from my family's experience this is a complicated issue that sometimes requires a team of experts to help your child succeed with what can be a debilitating condition. Please contact me via mefi-mail if you want more info or support.
posted by Biblio at 10:49 AM on June 20, 2008 [1 favorite has favorites]