Stimulant side effect FAQ

The following are commonly asked questions concerning the medical management of children with ADD, compiled by CHADD (Children and Adults with Attention Deficit Disorders) and the American Academy of Child and Adolescent Psychiatry.
What medications are prescribed for ADD children?
Medications can dramatically improve attention span and reduce hyperactive and impulsive behavior. Psychostimulants have been used to treat attentional deficits in children since the 1940s. Antidepressants, although used less frequently to treat ADD, have been shown to be quite effective for the management of this disorder in some children.

How do psychostimulants such as Dexedrine (dextroamphetamine), Ritalin (methylphenidate), Adderall (mixed amphetamine salts)and Desoxyn (methamphetamine) help?
Seventy to eighty percent of ADD children respond in a positive manner to psychostimulant medication. Exactly how these medicines work is not known. However, benefits for children can be quite significant and are most apparent when concentration is required. In classroom settings, on-task behavior and completion of assigned tasks is increased, socialization with peers and teacher is improved, and disruptive behaviors (talking out, demanding attention, getting out of seat, noncompliance with requests, breaking rules) are reduced.

The specific dose of medicine must be determined for each child. Generally, the higher the dose, the greater the effect and side effects. To ensure proper dosage, regular monitoring at different levels should be done. Since there are no clear guidelines as to how long a child should take medication, periodic trials off medication should be done to determine continued need. Behavioral rating scales, testing on continuous performance tasks, and the child's self-reports provide helpful but not infallible measures of progress.

Despite myths to the contrary, a positive response to stimulants is often found in adolescents with ADD; therefore, medication can be continued as the child reaches adolescence, if it is still needed.

What are common side effects of psychostimulant medications?
Reduction in appetite, loss of weight, and problems in falling asleep are the most common adverse effects. Children treated with stimulants may become irritable and more sensitive to criticism or rejection. Sadness and a tendency to cry are occasionally seen.

The unmasking or worsening of a tic disorder is an infrequent effect of stimulants. In some cases this involves Tourette's syndrome. Generally, except in Tourette's, the tics decrease or disappear with the discontinuation of the stimulant. Caution must be employed in medicating adolescents with stimulants if there are coexisting disorders, for example, depression, substance abuse, or conduct, tic, or mood disorders. In these cases, medication may not be appropriate. Likewise, caution should be employed when a family history of a tic disorder exists.

One side effect, decreased spontaneity, is felt to be dose-related and can be alleviated by reduction of dosage or switching to another stimulant. Similarly, slowing of height and weight gain of children on stimulants has been documented, with a return to normal for both occurring upon discontinuation of the medication. Other less common side effects have been described, but they may occur as frequently with a placebo as with active medication. Pemoline may cause impaired liver functioning in three percent of children, and this may not be completely reversed when this medication is discontinued.

Overmedication has been reported to cause impairment in cognitive functioning and alertness. Children may be attending to tasks, but their academic performance might suffer. Some children on higher doses of stimulants will experience what has been described as a rebound effect, consisting of changes in mood, irritability, and increases in the symptoms associated with their disorder. This occurs with varying degrees of severity during the late afternoon or evening, when the level of medicine in the blood falls. Thus, an additional low dose of medicine in the late afternoon, or a decrease of the noontime dose, might be required.