When ADHD Medications Are Not Working for Your Child

Medications for treating symptoms of attention deficit hyperactivity disorder (ADHD) can be very effective for children, making it easier for them to pay attention in school, maintain friendships, and basically navigate life. But sometimes, it's hard to determine the right medicine and the right dosage, with the best results and the fewest side effects. With some careful adjusting, however, it's almost always possible to find a medication and a dosage that works.

The most commonly prescribed ADHD medicines are Adderall (amphetamine and dextroamphetamine); Ritalin (methylphenidate ); Focalin (dexmethylphenidate); and Concerta (methylphenidate extended-release tablets). All of these drugs are stimulants, which are thought to work by increasing levels of a neurotransmitter in the brain called dopamine. This chemical is associated with motivation and attention, among other things. For many people with ADHD, stimulant medications both boost concentration and the ability to focus while at the same time curbing hyperactive and impulsive behaviors.

For the most part, ADHD drugs work. According to the ADHD treatment guidelines of the American Academy of Pediatrics (AAP), most children will respond to one of the stimulants. When a medication doesn't work or causes intolerable side effects, the options are usually to adjust the dose, either up or down, or switch to another medication. For example, if Adderall isn't relieving a child's symptoms or is making them cry a lot, then lowering their dosage or having them try one of the other stimulant medications may solve the problem.

A non-stimulant medication called Strattera (atomoxetine) is sometimes a good option for a child who isn't tolerating a stimulant. Some doctors also prescribe Strattera along with a stimulant, making it possible to lower the dose of the stimulant drug enough that it no longer causes side effects.

Other alternative medications used to treat ADHD include the medications Catapres (clonidine) and Tenex (guanfacine). These can be effective for impulsivity, hyperactivity, and sleep disturbances.

Sometimes if a child doesn't respond to two or three different stimulant medications and continues to do poorly, it may be that the ADHD diagnosis is wrong and that something else is causing the symptoms the child is experiencing. In this case, the AAP advises pediatricians to evaluate the child's diagnosis again and also have the child tested for a coexisting condition such as depression, bipolar disorder, or a learning disability or behavioral problem.

If you have a child with ADHD, putting various medications and dosages to the test to find what will work for him can be frustrating for you both. Don't hesitate to ask your pediatrician any questions you might have about effectiveness and timing (sometimes adjusting when the doses are taken can make a big difference). Let the doctor know about any side effects you believe are associated with your child's treatment. Don't be afraid to push for changes. There are many options available.