Understanding ADHD medications: What Parents Need to Know - Part Two

Ryan Wexelblatt (0:00)

Welcome everyone to part two of Understanding ADHD Medications, What Parents Need to Know. Today, we're going to talk about understanding stimulants, non-stimulants, SSRIs and some common myths around medication.

SPEAKER_2 (0:12)

Welcome to the ADHD Parenting Podcast with Mike McLeod of Grow Now ADHD and Ryan Wexelblatt of ADHD Dude. Learn about parenting kids with ADHD from a licensed clinical social worker and speech language pathologist who specializes in ADHD.

No fluffy parenting advice, only practical information that will equip you to help your child with ADHD effectively.

Mike McLeod (0:36)

In part one, we discussed long-term safety, long-term outcomes, common side effects, medication holidays, decision-making and genetic testing. In this episode, we are going to focus on the medications themselves. One of the biggest misconceptions is that all ADHD medications are basically the same. In reality, there are several different categories of ADHD medications and they all work very differently. Understanding the categories can help parents have better conversations with the child's prescriber. We will discuss Methylphenidate medications and Phetamine medications, Alpha agonists, non-stimulants like Sartara and Quelbery, SSRIs, and why pediatricians and nurse practitioners prescribe ADHD medications today.

All the research citations for this episode are available in the show notes.

Ryan Wexelblatt (1:34)

So the first thing we want to go over is the two stimulant families. Most parents do not realize stimulant medication falls into two major categories. They are Methylphenidate-derived medications and Amphetamine-derived medications. A child who does poorly on one stimulant class may do well on the other. This is why one medication not working does not mean that all stimulant medications will not work. I see that all the time. Parents tried one medication, the child did not have a good reaction to it, and they say, oh, stimulants don't work, which is not the case at all. So let's talk about first Methylphenidate-derived medications. Examples include Ritalin, Concerta, Focalin, and a newer medication that's actually taken at night called Jornay PM.

These medications are all in the Methylphenidate family, but they differ in delivery system, duration, onset, and how they feel across the day.

A parent should not assume that all Methylphenidate medications are identical just because they are in the same family. Please note that I only named a few of them there. There are many more than that.

Now, let's talk about Amphetamine-derived medications. Examples include Adderall, Vyvanse, and Dexedrine. These medications are in the Amphetamine family, but again, they differ by formulation, duration, release pattern, and individual tolerability. A study from Cortez and Associates in 2018 compared ADHD medications across children, adolescents, and adults and found stimulants had strong evidence for short-term symptom reduction with differences by age group and medication class. Another study in 2021 that we cited in the last episode by Dr. Ferrone, it was an international consensus statement summarized the strong evidence base for ADHD medications, particularly stimulants, while emphasizing treatment should be individualized. So please keep in mind, one medication not working for your child or your child having a negative reaction to it, does not mean that all stimulant medications will fail them. So let's go on and discuss a little bit about why finding the right medication often takes time.

Mike McLeod (3:46)

So parents can feel discouraged when the first medication does not work well. That is common. Finding the right medication often requires adjustments. A child may respond differently to different stimulant classes, doses, delivery systems, and durations of action. Some children need coverage mainly during school hours. Others need coverage into homework, sports, driving, or family time. Side effects may also differ by medication and formulation. This is another reason genetic testing does not solve the medication decision. Response is still best determined by careful monitoring during a medication trial.

The research here from Cortez in 2018, medication efficacy and tolerability vary across medications and age groups, supporting individualized prescribing rather than a one-size-fits-all approach.

Walrick in 2019, the AAP guideline emphasizes titration to achieve maximum benefit with tolerable side effects. So the key takeaway is medication trials are not a sign that the process is failing. They are often part of finding the right fit.

Ryan Wexelblatt (5:10)

In the next section, we're going to talk about what's called alpha agonists. These include medications like clonidine and guaficin and their extended release formulations. Now, something I often find parents get confused about, they hear non-stimulants and they think that clonidine and guaficin are basically an alternative to stimulants, which they are not. So alpha agonists are not stimulants. They work differently from stimulant medications. They may be prescribed alone or along with a stimulant. They are sometimes considered when a child has ADHD symptoms along with sleep concerns, hyperactivity, impulsivity, or difficulty tolerating stimulants.