Not all children and young people with ADHD or ADD need medication. Some will benefit from other forms of treatment such as  psychoeducation and pedagogical measures.

However, children with moderate to severe ADHD may also need medical treatment. However, it is important that pedagogical measures are first tried and that the pedagogical measures continue after treatment with medication is commenced. Medication is thus one element in a treatment programme and should not stand alone. 

Before start-up

When a child is diagnosed with ADHD, the following questions are considered:

• Whether the pedagogical measures have been sufficiently tested.
• Whether the child’s symptoms are so severe that there is a need for medication
• Whether the child receives sufficient support at school and at home.

If the use of medication is considered, you and your child will be invited to a start-up interview where you will be given information about the medication.

Before your child can begin treatment with medication, he or she must be examined by a nurse or a doctor, who will, for example, ask questions about your child’s health and check your child’s blood pressure and heart rate and measure his or her height and weight. Sometimes an electrocardiogram (ECG) will be done before starting up the medication. This only takes a very short time, and it does not hurt.

Start-up

The nurse or the doctor will tell you about the medication that your child will be given, how it works and any side effects you should be aware of. You will be given a dose escalation plan, and a time for a follow-up will be arranged.

Follow-up

It is often arranged that follow-up will be by email or telephone after four weeks. This is a chance for you as parents to report on any side effects and/or whether the medication is beginning to have an effect. In the event of any side effects, the dose escalation plan is adjusted.

After two to three months, your child is invited to a medication follow-up visit to see whether the medication is tolerated by your child and whether it is having an effect. At the follow-up visit, you will also talk about how your child is doing at school.

If your child tolerates the medication and the medication is effective, he or she will continue the treatment and be invited to a medication follow-up visit every six months. If the medication is not working, the person treating your child may adjust the dose or try another medication.

When the treatment has been stable for a while, your child will often be able to go to your family doctor for medication follow-ups. Some children need to go for check-ups with the psychiatric services for children and adolescents for a longer period of time.

Some children do not tolerate the medication, or the medication is not having an effect for them. In such cases, it may be necessary to stop the medication or wait until the child is older and perhaps better able to tolerate the treatment.

Why are blood pressure and heart rate measured?

ADHD medication sometimes results in slightly higher blood pressure and heart rate. This is usually not a problem, but if your child’s blood pressure or heart rate becomes too high or if he or she experiences symptoms, it may be necessary to stop the treatment, reduce the dose or try another type of medication.

Why are height and weight measured?

ADHD medication may reduce your appetite, and it is therefore important that we follow up on whether your child is growing as he or she should, despite being on medication.

If the doctor finds that your child’s growth is impacted, the doctor may decide to change to another type of medication or stop the medication altogether.

It is known that people with ADHD and ADD have lower levels and decreased functioning of the neurotransmitters dopamine and noradrenaline in specific parts of the brain. This imbalance causes problems with concentration, impulse control and restlessness. In fact, ADHD medication increases the level or functioning of dopamine and noradrenaline in specific parts of the brain.

Non-24-hour medication

All the medications in this group start working approximately 20-60 minutes after the child takes the pill. The short-acting medications work for for 3-4 hours, and the extended-release medications work for 6-12 hours.

Some children only need to be medicated during school hours and do fine without medication during their leisure time or at home. Other children also need their medication outside school hours.

At the same time, it differs from child to child how quickly they metabolise the medication. Therefore, the same medication may work for longer in some children, while in other children the effect does not last for as long.

Therefore, some children need to take medication several times a day to be properly helped, while other children only need to take their medication once a day.

Non-24-hour medication

Short-acting (work for 3-4 hours)

• Ritalin, Motiron, Medikinet
• Attentin

Extended-release medication

• Ritalin Uno, Medikinet CR, Equasym (work for 6-8 hours)
• Concerta/Methylphenidate (works for 8-10 hours)
• Elvanse (works for 10-12 hours)

24-hour medication

• Atomoxetine
• Intuniv/Guanfacine

Side effects

The various medications have different side effects. Many of the medications may result in reduced appetite and sometimes nausea.

Some children may experience low mood or aggression, while other children may find that their mood improves and they feel less aggressive. Similarly, some medications may make children more anxious, while some medications may reduce anxiety. Some children may not sleep as well on medication, while other children sleep better on medication.

Children affected by tics sometimes develop more, and more pronounced, tics, while other children have fewer tics when on medication. Blood pressure and heart rate may increase slightly, but this is usually not a problem.

24-hour medication

The 24-hour medication Atomoxetine has less of an impact on appetite. Intuniv is very different from the other medications: it lowers pulse and blood pressure slightly and often results in increased appetite.

The side effects often diminish as your child becomes used to the treatment, but sometimes it may be necessary to change the medication because of side effects.

NB: When to contact your child’s therapist:

Write or call your child’s therapist if you are unsure whether the medication is working as it should.

Always contact your child’s therapist if your child has severe side effects.

Treatment usually starts with one of the non-24-hour medications. These are the most well-known medications, and some of them are also the lowest-priced ones. The Danish Health Authority generally recommends starting with certain types of non-24-hour medication.

Sometimes Atomoxetine can be chosen to start with. Atomoxetine is often the first choice for children with severe anxiety and tics or for children who need to be medicated on a 24-hour basis.

An individual assessment must therefore be made by the therapist to decide on the best choice for the individual child.

Some medications are pills. Others are capsules that can be opened in order for the medication to be sprinkled on food or liquids, and finally some are in liquid form.

You may be eligible for reimbursement of medication expenses from the Danish Medicines Agency. The doctor treating your child will apply for reimbursement before the start of treatment.

Some ADHD medications may be abused if taken in much higher doses than prescribed by the doctor. As the medication can be abused, the authorities check carefully how much is prescribed to the individual patient. It is important that you as parents store the medication safely until your child becomes old enough to manage his or her own medication.

Some parents are concerned that ADHD medication may lead to an addiction to alcohol or narcotics later in life. There is nothing to suggest that this is the case. In fact, many studies show that treatment with ADHD medication can help reduce the risk of developing drug or alcohol abuse later in life.

ADHD and alcohol

In certain cases, ADHD medication may affect the effect of alcohol. Young people who take ADHD medication should therefore be extra careful about drinking alcohol.

Many continue to need medication when they become adolescents and adults. Others outgrow the need for medication.

At the follow-up consultations, you will talk about whether medication is still needed. If a young person wants to try whether he or she can do without medication or if you as parents would like to see how your child does without medication, we recommended that you discuss this with your child’s therapist.

An agreement can often be made to pause the medication for one to two months and to then assess together how things are going.