Medication Overview
Understanding ADHD medication - what it is, what it does, and how to make informed decisions about whether it's right for your child.
Note:
ADHD medications work by adjusting neurotransmitter levels - primarily dopamine and noradrenaline - in the brain.
This helps improve focus, reduce impulsivity, and regulate behaviour by making the prefrontal cortex function more effectively. It's like improving the "signal-to-noise ratio" in the brain.
Types of ADHD medication
Examples:
- •Methylphenidate (Ritalin, Concerta, Equasym)
- •Lisdexamfetamine (Elvanse)
- •Dexamfetamine
How it works:
Increase dopamine and noradrenaline availability in the prefrontal cortex.
First-line treatment. Most effective for most people. Despite the name, they don't "stimulate" - they improve signal clarity.
Examples:
- •Atomoxetine (Strattera)
- •Guanfacine (Intuniv)
- •Clonidine
How it works:
Various mechanisms affecting noradrenaline and other neurotransmitters.
Used when stimulants don't work, cause problematic side effects, or aren't appropriate.
What medication can and cannot do
- Improve focus and concentration
- Reduce impulsivity
- Help with task initiation and completion
- Reduce hyperactivity
- Improve working memory
- Make it easier to regulate emotions
- Reduce the gap between intention and action
- Cure ADHD - it manages symptoms while active
- Teach skills - still need to learn strategies
- Fix everything - other supports still needed
- Work equally for everyone - response varies
- Remove the need for accommodations
- Change personality or make someone "not themselves"
When is medication considered?
- •Moderate to severe symptoms causing significant impairment
- •Difficulties persist despite environmental adaptations
- •School functioning significantly affected
- •Self-esteem and relationships suffering
- •Safety concerns (impulsive behaviour)
- •Mild symptoms with specific contexts where extra help needed
- •Trial to assess impact (diagnostic tool)
- •When other strategies provide insufficient help
- •Very young children (under 5)
- •Mild symptoms with minimal impairment
- •When other conditions better explain symptoms
- •Against family wishes
Factors in the decision
| Factor | Consideration |
|---|---|
| Severity of impairment | How significantly are symptoms affecting school, relationships, and daily life? |
| Response to other strategies | Have environmental and behavioural approaches been tried? Are they enough alone? |
| Child's age | Medication evidence stronger for older children. Under 5s rarely medicated in UK. |
| Co-occurring conditions | Some conditions affect medication choice (e.g., anxiety, tics). |
| Family preferences | Your values and concerns are important. Medication should never be forced. |
| Practical factors | Ability to attend monitoring appointments, pharmacy access. |
- ADHD medication should be considered for children 5+ with moderate-severe ADHD
- Environmental modifications should be offered first or alongside
- Medication should be part of a comprehensive treatment plan
- Choice of medication based on individual assessment
- Regular monitoring is essential
- Shared decision-making with parents and child
Questions to ask your clinician
- Can you explain how you think medication might help my child specifically?
- What are the realistic expectations?
- What side effects should I watch for?
- How will we know if it's working?
- What monitoring will be needed?
- What happens if it doesn't work or we want to stop?
- How does medication fit with other support strategies?
Medication is a tool, not a cure or a moral issue. For many children with ADHD, medication provides genuine, meaningful help. For others, it's not needed or doesn't work well.
The decision should be based on your child's individual needs, response, and your family's values - not on fear, guilt, or pressure from others.