Considerations about Medication and ADHD

Stimulant medications are used by 2 to 4% of preschool and school-age students to treat the symptoms of ADHD (Gureasko-Moore et al., 2005; Zito et al., 2000). The table below provides information regarding the two major types of medications that are used to control the symptoms of ADHD.

Research has shown that methylphenidate is effective for most children and accounts for about 90% of prescribed medications for ADHD (Konopasek & Forness, 2004). However, the particular type of medication and dosage level that a student will respond to is unpredictable. Thus, it may be necessary to begin with one stimulant, closely monitor the effects (teachers may be asked to provide some of this feedback), and perhaps alter the dosage level or stimulant until an optimal response is achieved (Reiff, 2004).

Another consideration in selecting a medication relates to whether a short-acting or slow-release form of medication will be used.  The table below indicates, both methylphenidate and amphetamine come in short-acting, intermediate-acting, and extended-release forms. Some students respond more favorably to a sustained-release form of methylphenidate or amphetamine. Furthermore, longer-lasting forms of these medications reduce issues related to taking medication during the school day (e.g., forgetting to take the medication or interrupting school activities).

While stimulant medications are used to treat the vast majority of students with ADHD, other medications are used in some cases, including antidepressants or anti-anxiety medications. One of these medications, Strattera, is being used increasingly with school-age children and adults with ADHD. Strattera has side effects that are similar to stimulant medications, although they may be somewhat milder, and this medication lasts longer (up to 12 hours) than most stimulants.

When using medications to control the symptoms of ADHD, it also important that the child's parents and teacher closely monitor potential side effects. Educators are in a unique position because they can monitor the effects of medication on classroom behavior and academic achievement and also note how different dosage levels influence student behavior and achievement (Rosenberg et al., 2004). For example, in some instances when the level of the medication is too high, the child may behave "like a zombie" in class and be largely unresponsive to academic work and other school activities. Potential side effects of medications used to treat ADHD may include insomnia, decreased appetite, stomachache, headache, dizziness, and motor tics (Kollins et al., 2001).

In sum, a critical role for teachers and parents is to monitor the effect of medication on the child's behavior as well as any side effects that occur as a result of the use of medication. Moreover, the American Academy of Pediatrics (2001) in guidelines for the treatment of ADHD recommends that a sustained monitoring system be used to ensure that medication is effectively used. In particular, these guidelines recommend that parents and teachers gather information, monitor student outcomes, and track any adverse effects of medication. To ensure that these responsibilities are effectively addressed, teachers should have a basic understanding of the use of medications to control the symptoms of ADHD.