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Column originally published Jan 29, 2019

There Is No One Best Medicine For ADHD

Question: What is your number one recommended ADHD medication? Our son was diagnosed with ADHD. His doctor started him on Biphentin; it made him irritable and affected his sleep. He is now on Vyvanse. I want to give him a medicine that works. I don’t like trying one medicine after another.


Attention Deficit Hyperactivity Disorder (ADHD) is the most common brain condition affecting children worldwide. Many children, especially boys, are physically hyperactive. However, almost all are hyperactive in their brain; it is difficult for them to pay attention, or focus on task, especially if it is something that they are not interested in. Many are also impulsive, doing or saying things without thinking.

Research has identified many genes associated with ADHD. It affects several chemicals in the brain called neurotransmitters; these neurotransmitters help to pass messages from one nerve cell to another. The control centres in the front part of the brain cannot send messages to other areas of the brain that deal with focus, activity, and impulse.

ADHD medications help these neurotransmitters to function better, allow the control centres to increase focus, decrease hyperactivity and impulsivity. It is like giving these children invisible glasses for the brain, so that it can focus better, and improve their performance.

There are two classes of ADHD medications: stimulants and non-stimulants. Both Ritalin and Dexedrine are stimulants; they were discovered almost a century ago. They are both effective, but can have side effects like reducing appetite and affecting sleep.

In the last fifteen years, long-acting Ritalin- (Biphentin, Concerta, Foquest) and Dexedrine- (Adderall XR, Vyvanse) based medications have been produced. They can be taken once a day in the morning, before a child goes to school, and can work for most of the day.

Every child’s response to these medications is different. It is likely because each child inherits different sets of genes from his/her parents. It is not possible to know ahead of time which medicine may work.

I recommend trying one long-acting stimulant at a low dose, and increase every few days to the next higher dose. The brain needs time to adjust to the medicine. If it is effective, he can focus better in school, with less distraction or interruption; there may be less hyperactivity or impulsivity.

Both parents and teachers should monitor the benefits and side effects of medicine. Mild side effects are frequent, but they usually improve over time. If he is started on a relatively high dose at the beginning, the side effects can scare the family, even though the medicine is effective.

If one stimulant is ineffective or has unacceptable side effects, one can switch to another long-acting stimulant, beginning at a low dose. It is important to know that different long-acting stimulants work differently: Biphentin has more fast- acting Ritalin than Concerta or Foquest, therefore, Biphentin tends to work faster but wears off sooner. It is important to keep close contact with your doctor, and report how fast and how well the medicine works, for how long, as well as the observed side effects.

Once an effective medicine is found, stay on it daily, including weekends, holidays, and summer. After some weeks to months, his medicine may not work any more. It is usually because he has grown, and his brain has gotten used to the medicine. He just needs a slight increase in the dose.

In recent years, two non-stimulant ADHD medications were discovered: Strattera and Intuniv XR. They are often added to a long-acting stimulant to make it work longer and better, if it becomes necessary.

As you can see, there is no one best medicine for ADHD. The effect of medicine varies from person to person. I have seen non-identical twins responded to different ADHD medications.

I want to caution about using too low a dose of medicine that is somewhat effective. Don’t be content if the medicine stops him from interrupting the class, but he is still struggling to pay attention and to learn. If ADHD medicine is effective, he should be able to pay good attention in class, learn and do his work as well as his classmates, do his homework well, and relate well with everyone at home and in school.