Attention Deficit Hyperactivity Disorder medication that includes stimulants

The condition known as attention deficit hyperactivity disorder, or ADHD, is frequently linked to a variety of other behavioral or emotional issues, as well as poor academic performance. In clinical trials, approximately 70 percent of the children who were given stimulant medication experienced clinically significant improvements in their condition as a result of the treatment, particularly when the medication was combined with behavioral management. However, between 35 and 40 percent have a response that is comparable to placebo. If patients receiving drug treatment are carefully evaluated and monitored, there are relatively few risks to the treatment in the short term. The potential risks over the long term are not known.


Attention deficit hyperactivity disorder, also known as ADHD, is characterized by inappropriately persistent overactivity, impulsivity, and inattention for the child's mental age. 1 Attention deficit disorder was the previous name for this condition. The exact prevalence rate is unknown in Australia, and it depends on whether or not the U.S. S A or European diagnostic criteria are used The diagnostic criteria that are used in Europe are less stringent, which results in a lower prevalence. 2 This medical condition is referred to as hyperkinetic syndrome in Europe. It appears that the condition occurs 5–10 times more frequently in boys than in girls, but the gender ratio may be skewed because the diagnostic criteria reflect boyish behaviors. Imaging studies of the brain show signs of abnormal function in the limbic and frontal regions. 3 , 4


Some children develop attention deficit hyperactivity disorder (ADHD) after suffering a brain injury, but it is believed that the condition is inherited by the majority of those who are affected. Even though symptoms of the disorder typically start to show up in early childhood, children typically aren't referred for clinical evaluation until they are old enough to attend school. The hyperactive behaviors typically subside by the early adolescent years; however, difficulties with impulse control and inattention may continue into adulthood. A sizeable portion of children, adolescents, and young adults who have Attention Deficit Hyperactivity Disorder (ADHD) go on to engage in antisocial behaviors, abuse alcohol and other drugs, or develop additional psychiatric disorders. Underachievement in both academic and vocational endeavors is quite common.


If the conventional letter U S A If these criteria (DSM-IV) are used to make the diagnosis, the child's symptoms must have first appeared prior to the age of seven. The symptoms must be maladaptive, inappropriate for the child's age, lead to significant impairment, and be present in at least two settings before the child can be diagnosed with autism spectrum disorder. g both at home and at school

According to the DSM-IV criteria, in order for a child to be diagnosed with attention deficit hyperactivity disorder (ADHD), the child must meet 6 of the criteria for inattention, as well as 6 of the criteria for hyperactivity/impulsivity (see box). It is now possible to make a diagnosis of inattention without hyperactivity or impulsivity, and it is now possible to make a diagnosis of hyperactivity or impulsivity without inattention; however, the clinical utility of these categories has not yet been demonstrated.

The percentage of people who are diagnosed is highly variable across the continent of Australia. It is possible that this, rather than differences in state regulations (Table 1), is the cause of the variable prescribing rate for stimulants (Table 2). It would appear that prescribing doctors frequently use various assessment procedures that are based on a variety of different theories when making their diagnoses of ADHD in their patients. In some areas of Australia, the condition is probably both over diagnosed and under diagnosed more often than it should be.


It is still debatable whether or not ADHD should be considered its own distinct syndrome. This is due to the fact that the symptoms change depending on the environment, and the majority of people who have ADHD also have associated issues. Some examples of these issues are behavioral disturbances, difficulties in learning, emotional disorders, and dysfunction in the family. There is a high incidence of maladaptive parenting behaviors, but it's possible that these behaviors are more of a result than a cause of the child's symptoms. There is a very specific overlap between Tourette's syndrome and ADHD, given that seventy-five percent of people diagnosed with Tourette's also have clinically significant ADHD. There are many children who are developmentally delayed who exhibit some behaviors that are similar to ADHD, but they do not meet the diagnostic criteria for ADHD when their mental age is taken into consideration.


In recent years, attention deficit hyperactivity disorder (ADHD) has received a significant amount of publicity; as a result, parents are generally very well informed about the disorder. They are likely to go to the family doctor with very specific expectations regarding the medical care that can be provided for their child in order to alleviate their symptoms. If a physician is asked to examine a child for possible ADHD, he or she is obligated to examine the child for obvious signs of developmental delay as well as speech, language, hearing, visual, and neurological issues. If the child has not been seen by a counselor before, the practitioner ought to request from the parents that they make an appointment for them with the school counselor. It's possible that the counselor will be able to pinpoint specific learning issues, as well as offer guidance to the teachers on how to deal with disruptive behavior in the classroom. Given the availability of a number of effective treatments for attention deficit hyperactivity disorder (ADHD), it is reasonable to express optimism to both the child and the parents.

If they have any reason to suspect that a child suffers from ADHD, general practitioners should seek the advice of a specialist. In most cases, the specialist verifies the diagnosis by gathering information from a number of different sources, such as patient histories and standardized behavior checklists, in order to establish whether or not the symptoms are pervasive. Some clinics provide specialized EEG and psychometric examinations, but it is debatable whether or not these contribute to the diagnostic process.


In most cases, treatment consists of educating the child, the child's parents, and the child's teachers about the nature of the problem and the likely course it will take. It's possible that parents will be given techniques to help them handle their children's disruptive behavior. Despite the fact that the role of this approach is still up for debate, there is a subset of people who suffer from ADHD who find that the assessment and management of their food hypersensitivities is beneficial. The evidence for a specific association between attention deficit hyperactivity disorder and allergic disorders is inconclusive. 5 , 6 It is common practice to ask the treating physician to act as an advocate on the child's behalf in the process of acquiring specialized educational services and disability benefits.

Items deserving of inattention:
The child is frequently in trouble.

  • makes careless errors in their schoolwork, work, or other activities because they do not pay close enough attention to the details.
  • has trouble maintaining attention while working or participating in play activities
  • does not give the impression of listening when directly addressed.
  • does not carry out instructions and does not complete schoolwork, chores, or duties at work (not due to oppositional behavior or an inability to understand instructions)
  • struggles to organize their responsibilities and their activities.
  • tasks that require sustained mental effort (like schoolwork or homework) are activities that the individual avoids, dislikes, or is hesitant to engage in.
  • loses things that are necessary for performing tasks or participating in activities (e g (playthings, schoolwork, homework, writing implements, reference materials, or tools)
  • is easily sidetracked by irrelevant or distracting stimuli
  • is prone to forgetfulness in everyday situations

Items related to hyperactivity and impulsivity:
T he child often

  • wiggles their hands or feet, or wiggles around in their seat.
  • leaves their seat in the classroom or in other situations where it is expected that they will remain seated.
  • excessively moves around or climbs in situations where either behavior is not appropriate (in adolescents or adults, this behavior may be limited to subjective feelings of restlessness).
  • has trouble keeping quiet while playing games or engaging in other types of leisure activity
  • acts in a manner consistent with being "driven by a motor" or "on the move."
  • excessively talks; talks a lot
  • provides responses before the questions have been finished being asked
  • struggles with waiting for their turn.
  • interferes with or intrudes on the activities of others (e g rams his way into other people's conversations or games)

Table 1

The prescription of stimulants for children diagnosed with ADHD must comply with state and territory regulations.

prescribers Health Department
approval needed A C T Neuropediatricians and Pediatricians


Yes N S W Pediatricians and Child Psychologists and Psychiatrists

Other prescribers who have the necessary experience and credentials (approved by the Department on the recommendation of the Medical Committee's Stimulants Subcommittee) are allowed to write prescriptions for stimulants.

Yes N T Any medical professional who is not currently working for the N T The government can write the prescriptions, but only N will be able to dispense the stimulants. T hospital pharmacies if the prescription is endorsed for attention deficit disorder and written by or with the approval of an attention deficit disorder specialist psychiatrist or paediatrician. Medical officers working for the government who want to prescribe stimulants for attention deficit disorder need to have qualifications in either pediatrics or psychiatry. Qld Any licensed physician, provided that the prescription bears the notation "Specified Condition." If treatment is expected to last longer than two months, the Chief Health Officer should be notified. S A Neuropediatricians and Pediatricians

Psychologists or other medical professionals who work with one of these specialists and have their support

After a period of 2 months, yes. Tas Neuropediatricians and Pediatricians


Yes Vic Neurologists Yes Paediatricians
Psychiatrists Yes after 2 months W A Paediatricians Paediatric neurologists

Psychiatrists who specialize in pediatrics

Yes after 30 days
Table 2


Please take into account the data that was provided by the Drug Utilization Sub Committee of the Pharmaceutical Benefits Advisory Committee.


Even though pharmacotherapy is still the single most effective treatment strategy, its effectiveness can be increased by involving both the parents and the teachers in the behavioral management of the patient. The most common treatments for attention deficit hyperactivity disorder (ADHD) are the stimulants methylphenidate and dexamphetamine. Some patients have benefited from using tricyclic antidepressants, clonidine, moclobemide, and thioridazine as stand-alone treatments or in combination with stimulants. These medications are considered to be second-line treatments. Although the effectiveness of the tricyclics is comparable to that of the stimulants, it has not yet been determined whether or not the other drugs are also effective. 7


Inhibition of the reuptake of noradrenaline and dopamine is just one of the many effects that stimulants have. It was once believed that they worked by paradoxically sedating the hyperactive child; however, it has been shown that they work by preferentially stimulating inhibitory pathways in the brain. The effect is dose dependent, and once the therapeutic dose has been exceeded, the stimulants will begin to have an activating effect. The stimulants are only clinically effective in the majority of children for three to four hours, which means that the child will need at least two doses in order to receive adequate coverage throughout the school day. The vast majority of children need their medication seven days a week, but it is uncommon for them to build up a tolerance to it.


There is some evidence that suggests that attention can be improved with low doses, but it appears that higher doses are required to control hyperactivity and impulsivity adequately. It is well established that, over the short term, effectiveness in improving performance on tasks requiring sustained attention can be achieved. 70% of children in clinical trials show a clinically significant response, while only 35%–40% of children in these trials respond to the placebo. 8 , 9 On the other hand, there is only equivocal evidence to suggest that stimulants improve the functioning of children who have ADHD over the longer term. 10 The vast majority of parents and clinicians have the expectation that stimulant therapy will lessen the likelihood of the child developing secondary problems such as conduct disturbance; however, the drugs do not have a direct impact on the child's behavior or learning difficulties. It is possible that the child's compliance with instructions can be improved by increasing their attention span and decreasing their impulsivity. This could help the child qualify for special education programs, which would lead to an improvement in academic performance in a roundabout way.

It would appear that the effects of dexamphetamine and methylphenidate are comparable. There is no way to determine in advance which medication will be the most effective treatment for a specific child.

Negative consequences

Suppression of appetite and initial insomnia are two of the most common unintended effects of treatment. Due to the fact that children with ADHD may already be picky eaters or have a lack of interest in food and struggle to get to sleep, these negative side effects can present a significant challenge for the children's parents. After taking a stimulant, some children will also report experiencing headaches as well as discomfort or pain in the gastrointestinal tract.

Because children are unlikely to eat much while the drugs are working, a useful strategy is to give the child a substantial breakfast before the morning dose, accept that lunch will probably come home untouched, and allow the child to snack before bedtime. This is because children are unlikely to eat much while the drugs are working. Children who are taking stimulants and develop insomnia should not receive their medication after 1 p.m. m On the other hand, a dose taken after school that is sufficient to cover the child's homework load may be of significant assistance to children who do not develop insomnia.

Sometimes, even relatively low doses of stimulants can have a very stimulating effect. It has also been demonstrated that stimulants can bring out stereotypical behaviors and tics in people. Despite this, the vast majority of people who suffer from Tourette's syndrome and are treated with stimulant medication do not experience an increase in the frequency or severity of their tics. When treating a child who has a history of seizures, exercise extreme caution because stimulants lower the threshold at which seizures can occur. Agitation, hyperarousal, delusional thinking, hallucinations, and confusion are some of the symptoms that can accompany stimulant toxicity.

Children may have reasonable concerns that their peers will tease or harass them, and these concerns may be based in reality. When there is a problem with this, it frequently reflects the ambivalent attitudes that school staff members have toward treatment. In most cases, avoiding this problem entirely can be accomplished through liaison with the school. Children who have been treated can occasionally exhibit mood swings, but keep in mind that this is already a vulnerable population. In most cases, emotional blunting does not occur, unless the dosage of the stimulant is significantly higher than recommended. Both persistent depression and preoccupation with suicidal thoughts are serious symptoms that need to be evaluated as soon as possible by a child psychiatrist.

The use of stimulants for extended periods of time has not been linked to any specific adverse effects as of yet. Recent research has shown that the initial concerns regarding effects on growth were unfounded. 11


Treatment for addictive behaviors is not recommended for children younger than four years old. It is standard procedure for me to ascertain whether or not the child's symptoms prevent them from attending school. Because of this, I reserve the majority of my prescriptions for stimulants for children who have been in school for at least a year. In many cases, after discussing the matter with the patient's parents, I decide to hold off on prescribing medication to see if the patient's symptoms improve on their own.

The determination of whether or not to put a child on stimulants is predicated on an evaluation of the level of social or academic impairment brought on by the child's symptoms. The perspective that the parents hold on drug treatment and their capacity to monitor its implementation should also be evaluated.

The presence of anxiety or a severe mental disturbance, such as psychosis, are both conditions that rule out the possibility of receiving treatment. The presence of tics and other abnormal movements is a relative contraindication. If there is a history of these issues in either the child or the family, the child ought to be evaluated by a specialist who is experienced in the treatment of these disorders. It is still possible to get a prescription for stimulants, but both the child's parents and the child themselves need to be fully informed of the risks. 8 The child will need to be observed very carefully in the event that the unusual movements become even more pronounced.

Before beginning treatment with stimulants, the practitioner should inquire about a personal or family history of tics or other abnormal movements. This should be done regardless of whether or not the patient currently demonstrates any of these symptoms. Recording the child's height and weight, in addition to their pulse rate and blood pressure, is a requirement. It is the responsibility of the parent to notify the school that the child will be taking medication. The dose that is given to the child should begin at the lower end of the recommended range that is based on weight, and it should be increased gradually until an optimal response is achieved. The recommended dosage is zero. 15-0 5 mg/kg per day for dexamphetamine, and 0 3-1 0 mg/kg per day for methylphenidate Both dexamphetamine and methylphenidate are only available in the form of tablets in Australia, with the respective dosages being 5 mg and 10 mg. The dosing options are therefore more restricted as a result, but the tablets can be easily split in half.

When the patient returns for follow-up appointments, the medical professional should inquire about any adverse effects and perform routine checks on the patient's height, weight, pulse, and blood pressure. It is possible to monitor the patient's response to treatment by using behavior rating scales; however, the narrative comments made by the instructor at the end of the school report are frequently just as informative. During the early stages of treatment, children should be seen as frequently as possible; however, as the child's condition improves and treatment becomes more stable, the child's visit frequency should gradually decrease. It is reasonable to try the alternative medication in the event that the child does not respond favorably to a sufficient trial of the initial stimulant. On the other hand, if the child has a significant negative reaction to one medication, the alternative will most likely have the same effect, and a drug from a second line of defense should be considered.

It is difficult to determine the length of time that treatment should be administered for, but patients should have their conditions evaluated every six months. Evidence of a significant relapse in symptoms when medication is withheld may be required in the majority of states as part of the process to justify the continuation of permission to prescribe. If the drug is not given to the child while they are at school, during the time of day when their attention span is being tested the most and when both the parent and the teacher are present to make observations, a more accurate indication of whether or not the child has relapsed can be obtained.

The child's level of functioning as a whole, in addition to the degree to which symptoms reappear during treatment breaks, should be taken into consideration when making the decision to terminate treatment. Rarely will a person experience adverse withdrawal symptoms, but if symptoms have been well controlled with medication, a rebound in symptoms can be quite distressing for both the patient's family and the caregiver.

It is essential that the healthcare provider maintains a level of reasonable accessibility to the parents via telephone. If you decide to treat your child with stimulant medication, you will need to make a long-term commitment to the patient as well as the patient's parents.


The following assertions are either true or false, depending on the context.

1. The use of stimulants to treat attention deficit disorder is more effective than the behavioral management of the condition

2. Children who take stimulants should have their height and weight measured regularly because the drugs have the potential to speed up the growth process.

The solutions to the questions in the practice exam

1. True

2. False

  1. Rey JM, Hutchins P. Childhood hyperactivity. Med J Aust 1993;159:289-91.Childhood hyperactivity. Medical Journal of Australia 1993;159:289-91. Rey JM and Hutchins P.
  2. Schachar R. Childhood hyperactivity. J Child Psychol Psychiatry 1991;32:155-91.Childhood hyperactivity, published in J Child Psychol and Psychiatry in 1991;32:155-91. Schachar, R.
  3. Zametkin AJ, Nordahl TE, Gross M, King AC, Semple WE, Rumsey J, et al. Cerebral glucose metabolism in adults with hyperactivity of childhood onset [see comments]. N Engl J Med 1990;323:1361-6. Comment in: N Engl J Med 1990;323:1413-5. Comment in: N Engl J Med 1991;324:1216-7.[see comments]. N Engl J Med 1990;323:1361-6. Comment in: N Engl J Med 1990;323:1413-5. Comment in: N Engl J Med 1991;324:1216-7. Zametkin AJ, Nordahl TE, Gross M, King AC, Semple WE, Rumsey J, et al. Cerebral glucose metabolism in adults with hyperactivity of childhood onset.
  4. Weiss G. Hyperactivity in childhood [editorial; comment]. N Engl J Med 1990;323:1413-5. Comment on: N Engl J Med 1990;323:1361-6.Hyperactivity in childhood [editorial; comment], New England Journal of Medicine 1990;323:1413-5. Editorial and comment on: New England Journal of Medicine 1990;323:1361-6.
  5. Weiss G. Attention deficit hyperactivity disorder. In: Lewis M, editor. Child and adolescent psychiatry. A comprehensive textbook. Baltimore: Williams & Wilkins, 1991:551Child and Adolescent Psychiatry: A Comprehensive Textbook was published in Baltimore by Williams & Wilkins in 1991:551 and was written by Weiss G. Attention Deficit Hyperactivity Disorder.
  6. McGee R, Stanton WR, Sears MR. Allergic disorders and attention deficit disorder in children. J Abnorm Child Psychol 1993;21:79-88.Allergic disorders and attention deficit disorder in children, by McGee R, Stanton WR, and Sears MR, published in the Journal of Abnormal Child Psychology in 1993;21:79-88.
  7. Spencer T, Wilens T, Biederman J. Tricyclic antidepressant treatment of hyperactivity. Curr Opin Psychiatry 1994;7:304-7.Treatment of hyperactivity with tricyclic antidepressants, according to Spencer T, Wilens T, and Biederman J in the journal Curr Opin Psychiatry 1994;7:304-7.
  8. Simeon JG, Wiggins DM. Pharmacotherapy of attention deficit hyperactivity disorder. Can J Psychiatry 1993;38:443-8.Pharmacotherapy of attention deficit hyperactivity disorder. Canadian Journal of Psychiatry 1993;38:443-8. Simeon, J.G., and D.M. Wiggins.
  9. Barkley RA. A review of stimulant drug research with hyperactive children. J Child Psychol Psychiatry 1977;18:137-65.RA Barkley, "A review of stimulant drug research with hyperactive children," Journal of Child Psychology and Psychiatry, volume 18, issue 1, pages 137–65, 1977.
  10. Waters BG. Psychopharmacology of the psychiatric disorders of childhood and adolescence. Med J Aust 1990;152:32-9.Psychopharmacology of the psychiatric disorders of childhood and adolescence, by Waters BG, published in the Medical Journal of Australia in 1990 at volume 152 pages 32-9.
  11. Gadow KD. Pediatric psychopharmacotherapy: a review of recent research. J Child Psychol Psychiatry 1992;33:153-95.Pediatric psychopharmacotherapy: a review of recent research, by Gadow, K.D., published in J Child Psychol Psychiatry in 1992;33:153-95.
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