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Column originally published May 26, 2015

New ADHD Medications

Question: I grew up with ADHD. I was hyperactive and disruptive in class. My doctor gave me Ritalin and then Dexedrine; they did help me to pay attention, but I didn’t like the way that medicine made me feel. I had to take it several times a day. I finally stopped taking medicine when I was a teenager, and got into a lot of trouble with drinking and using drugs. It took many years before I stopped these. My wife was never diagnosed, but she was a daydreamer in school, and dropped out in high school. Like me, she got into drugs. Now, our six-year-old daughter has difficulty learning and cannot focus, and our four-year-old son is just like me when I was young. We are worried that they may need medicine and go down the same path. Is there anything better that can help children with ADHD?


I am glad that you are asking this question when your children are still young.  There is better help available nowadays than when you were growing up.  Attention Deficit Hyperactivity Disorder (ADHD) is a genetic condition that can be passed from parents to children.  Very often, when we see children with ADHD, their parents would recognize that they have the same problems all along.

Traditionally, ADHD has been treated with Ritalin and Dexedrine.  These are stimulant medications that can help children to focus, make them less hyperactive and less disruptive.  They were available in short-acting formulations; children have to take them several times a day to pay attention in school and in doing homework.  They are rapidly absorbed and eliminated, producing peaks and valleys in the body which account for the majority of side effects.  Some parents thought the medicine turns their children into zombies.

However, better long-acting formulations have become available.  There are two Ritalin-based medications: Concerta and Biphentin.  Although both are Ritalin-based, they work quite differently.  Concerta has a lower peak and can work into the evening, while Biphentin has a higher peak and works for shorter period of time.  Some parents prefer one over the other.  In the past few years, there is a generic formulation of Concerta that works more like Biphentin.  Most parents find that generic Concerta is not nearly as effective as brand-name Concerta.

Adderall XR and Vyvanse are the long-acting Dexedrine.  Adderall XR has Dexedrine and two closely-related chemicals combined together and works for 8-10 hours.  Vyvanse is a pro-drug of Dexedrine.  It needs an enzyme in our body to release the Dexedrine; as a result, it is a long-acting medication.

Vyvanse is the only stimulant medicine that cannot be abused.  All other long-acting medications can still be abused, although not easily.  Most drug addicts prefer short-acting Ritalin and Dexedrine to get high because they can be crushed and snorted or injected.

There are two non-stimulant ADHD medications: Strattera and Intuniv XR.  These are not nearly as effective as Ritalin- and Dexedrine-based medications.  Most of the time, they are added to stimulant medications to improve their effectiveness instead of being used alone.

Because of advances in medications, children need to take their medicine once a day in the morning, and it is effective for most of the day.  There are less side effects and better compliance.  Children with ADHD can succeed just like everyone else.  When they stay on medication in their teenage years, they are less likely to experiment with drugs and alcohol, or get into trouble with the law.

Many teachers are more aware of ADHD.  However, it is still difficult to detect daydreamers; these children fall behind in learning and don’t achieve their potential.  This may be the situation with your daughter.  You should request a referral to a paediatrician who can properly assess her.  Early treatment can help her to focus, improve her learning, and gain self-confidence.