ADD: General Medication Questions

Which medications work best?
There's no single answer to this question. In most patients, stimulants emerge as the drug of choice, but in others they don't work at all. Even within these categories, the responses of individual patients can be very different, often for no discernible reason. One child may do fine on Ritalin but not Dexedrine; for another it may be just the reverse. One may experience troubling side effects while his classmate has no such side effects.

How, then, do doctors know which medications to use?
Unfortunately, there's no good way to predict the response to a type of medication or a dosage schedule. So don't be surprised by some degree of trial and error as you try to get it right.

Each medication has its pros and cons, and we'll look at each of them in turn later in this chapter.

Are generics equivalent?
In my experience, no--especially the generic equivalent of Ritalin. If your health care prescription plan restricts you to certain medications, you may have trouble getting brand name Ritalin covered. Different plans have different rules, but if you encounter this problem, it's sometimes possible to win an exception if your doctor documents that the generic medication wasn't effective or files an appeal with the insurer.

How soon can I expect to see results?
With stimulants, you can see some changes in behavior very quickly--even with the very first dose. Other types of medications typically take longer to start working. Antidepressants, for example, may require up to three weeks before effects are noticeable. However, with all of these medications, you should see definite changes within a couple of months.

What should I do if the medication isn't working?
About 25 percent of patients don't respond to the initial medication, or have too much trouble with side effects to stay on it. But there's good news: Patients often do well with another medication of the same type. So, for example, if Ritalin isn't helping your child, ask your doctor to consider switching him or her to Adderall or Dexedrine, and vice versa. If the stimulants don't work, ask the doctor to consider other classes of drugs instead. Also, combinations might work where single medications don't.

If medication isn't making a difference after a reasonable period of time, there's no reason to continue the same treatment regimen in the hope that it will eventually improve. Schedule an appointment with your child's physician to look at how the treatment should be modified.

Here's what you and the doctor should consider:

• The medication--another drug or class of drugs may work better.
• The dosage--if you're not seeing improvement, the dosage may need to be increased or the timing of the doses changed; if side effects are a problem, consider reducing the dosage, either temporarily or permanently.
• The diagnosis--if medication isn't proving effective, take another look at the diagnosis. Your child may have an ADHD mimicker--a different condition whose symptoms resemble ADHD.
• Comorbid disorders--as we've seen, problems such as learning disorders or anxiety often go hand in hand with ADHD. If, for example, your child has a comorbid learning disorder, you won't see much progress if you're only treating the ADHD. That doesn't mean you should stop treating the ADHD and focus only on the LD; you need to treat both.