Medication for attention deficit hyperactivity disorder (ADHD)
Strong evidence – there is lots of high-quality evidence that some young people find this treatment option helpful.
Taking medication will not cure your ADHD. It might help you to concentrate better, be less impulsive, feel calmer and make it easier to learn at school, college, university or at your work. You should only be offered medication if your ADHD symptoms are causing you a lot of problems and the support offered to your parents or carers and making changes to your environment have not helped.
Before offering you medication, your professional should talk with you and your parents or carers about:
- the benefits and risks of psychological support and medication
- the benefits of a healthy lifestyle and exercise
- your views, preferences and any worries you have about taking medication
- how any other physical or mental health conditions you might have could affect your treatment choices
- the importance of sticking to a treatment, and things that might make sticking to treatment more difficult
You should be encouraged to share how you feel, and your preferences and concerns should be part of your treatment plan. If you are able to make your own decisions about your treatment then you will be able to decide whether you would like to take medication for your ADHD. You can still involve your parents or carers in this decision if you would like to and your professional should explain that you can change your mind about the medication at any time.
What should happen before the medication is started?
Before you start any medication, you and your health professional should talk to see how you are. This is sometimes called an assessment and should include:
- making sure that you still need medication
- any other physical or mental health conditions you have
- how things are at school (your professional might ask for a report from your school so they can see whether the medication helps with your learning)
- any difficulties you’re having with behaviour
- how things are at home
- whether you need help to use the medication properly
- your care needs
Some ADHD services use something called a QB test. This is a short activity on a computer that can measure how well you can pay attention, how impulsive you are and how much you move or fidget. This can be helpful to understand whether you have ADHD and to keep track of whether your medication is helping.
Your professional might also ask about any other medication you take and your general health, like how your heart is working, your blood pressure, and check your medical history, height and weight.
If you are at risk of having heart problems or if your blood pressure is high, you should be referred to a heart specialist before starting ADHD medication.
Which medications are prescribed for ADHD?
Medication for ADHD can only be started by an ADHD specialist, for example a psychiatrist, nurse prescriber or a paediatrican.
There are five types of medicine licensed for the treatment of ADHD:
- methylphenidate
- lisdexamfetamine
- dexamfetamine
- atomoxetine
- guanfacine
Some medications need to be taken every day, but some can be taken just on school days. If you need to take medication during the school day then a member of school staff will keep your medication in a safe place and give you the medication when you need it. Sometimes your professional might suggest that you take a break from the medication to see how you are and whether you still need to take it.
If you are prescribed one of these medication options, you will probably be given a small dose at first which might then gradually increase depending on how much the medication is helping.
Read more about each ADHD medication
- Methylphenidate
Methylphenidate is the most commonly used medication for ADHD and should be offered as your first medication option. Methylphenidate can help ADHD symptoms by increasing activity in parts of the brain which control attention and behaviour.
This medication can be taken as either immediate-release tablet and where the effects last about four hours (small doses taken two to three times a day) or as modified-release tablets where the effects last six-twelve hours depending on the brand (these are taken once a day in the morning, with the dose released throughout the day). Some people take methylphenidate on school days only.
Common side effects of methylphenidate include:
- a small increase in blood pressure and heart rate
- loss of appetite, which can lead to weight loss or poor weight gain and growth problems
- headaches
- stomach aches
- feeling aggressive, irritable, depressed, anxious or tense
Read more about methylphenidate for children here.
If methylphenidate is not effective, lisdexamfetamine (another stimulant) might be suggested.
- Lisdexamfetamine
Your professional might suggest lisdexamfetamine if you’ve had a six week trial of methylphenidate, but your ADHD symptoms did not improve enough for you to continue.
It works by stimulating certain parts of the brain and can improve concentration, help focus attention and reduce impulsive behaviour.
Lisdexamfetamine comes in capsules, taken once a day. Some people take Lisdexamfetamine on school days only.
Common side effects of lisdexamfetamine include:
- decreased appetite, which can lead to weight loss or poor weight gain
- aggression
- drowsiness
- dizziness
- headaches
- diarrhoea
- nausea and vomiting
- Dexamfetamine
Your professional might suggest dexamfetamine if your ADHD symptoms improved while you were taking lisdexamfetamine, but you could not tolerate its longer-lasting side effects. Dexamfetamine is a stimulant medication licensed to treat hyperactivity in children over five years old, but its effect lasts for a shorter amount of time than lisdexamfetamine. However, there is a greater potential for misuse than with other types of medications, and so dexamfetamine is unlikely to be the first medication offered to you.
Dexamfetamine is usually taken as a tablet two to four times a day, although a liquid option is also available. Some people take dexamfetamine on school days only.
Common side effects of dexamfetamine include:
- decreased appetite
- mood swings
- agitation and aggression
- dizziness
- headaches
- diarrhoea
- nausea and vomiting
- Atomoxetine
Atomoxetine works differently from other ADHD medication. It's a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing it can help with concentration and controlling impulses.
Your professional might suggest atomoxetine if it's not possible for you to take methylphenidate, lisdexamfetamine or dexamfetamine. This might be because you have other health problems which means that you can’t take stimulant medication or because you have had problems with side-effects from these medications. Atomoxetine comes in capsules and is usually taken once or twice everyday.
Common side effects of atomoxetine include:
- a small increase in blood pressure and heart rate
- nausea and vomiting
- stomach aches
- trouble sleeping
- dizziness
- headaches
- irritability
Atomoxetine has been linked to some more rare but serious side effects that are important to look out for, including suicidal thoughts and liver damage. Your professional will be able to give you more information about these if you start to take atomoxetine.
- Guanfacine
Your professional might suggest guanfacine if it's not possible for you to take methylphenidate or lisdexamfetamine. This might be because you have other health problems which means that you can’t take stimulant medication or because you have had problems with side-effects from these medications. Guanfacine is usually taken as a tablet once a day, in the morning or evening and needs to be taken everyday. As well as helping to improve attention, guanfacine can also reduce blood pressure.
Common side effects include:
- tiredness or fatigue
- headache
- abdominal pain
- dry mouth
If atomoxetine or guanfacine are not effective, your professional should obtain a second opinion or refer you to a specialist service.
- Other medications
There are other medications which are much less commonly used to treat ADHD. They are unlicensed for treatment of ADHD and NICE recommend they should only be prescribed with advice from a specialist ADHD service. In practice this means a second opinion from a psychiatrist or paediatrician who is a specialist in treating ADHD.
Clonidine is a medication originally developed to treat high blood pressure that can be helpful if you have:
- tics as well as ADHD
- sleep problems that haven’t been helped by other interventions
- sleep problems that are being caused by stimulant medication
Atypical antipsychotic medications (such as risperidone and aripiprazole) are sometimes prescribed in addition to stimulants if you have ADHD and feelings of aggression, rage or irritability that have not responded to psychological interventions (or if psychological interventions have not been possible).
There is little research evidence for this type of medication and there are concerns that stimulant and antipsychotic might not be helpful when taken together.
- Monitoring medication effects
When you have just started taking medication your appointments will usually take place more frequently. This will involve regular monitoring of your ADHD symptoms and side effects, and your medication dose might be adjusted to find a level where your ADHD symptoms are reduced but any negative effects are manageable.
Once you have found the right dose you will still have appointments with your ADHD professional every six-twelve months to monitor whether your ADHD symptoms are improving and whether you are experiencing any negative effects. In between these appointments your GP or pharmacist might need to monitor your growth, heart rate, blood pressure and any side effects of the medication. If you experience any problems with the medication then you will usually go back for an appointment with the ADHD professional.
Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.