When to Consider Medication for Children with ADHD

Discover tips, treatment options, and support strategies from the Finding Focus Care Team

Last Update: March 3rd, 2025 | Estimated Read Time: 5 min

Understanding ADHD and Its Challenges

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders affecting children today. It is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily life. According to Polanczyk et al. (2007), approximately 5% of children worldwide are diagnosed with ADHD, and the numbers are steadily rising.

Parents and caregivers of children with ADHD often face difficult decisions about how to best manage symptoms. While behavioural interventions are the first line of treatment, medication is sometimes necessary to help children function effectively at home, in school, and in social settings. But when should medication be considered? This article explores the factors that can help determine if and when ADHD medication is the right choice for a child.

Initial Approaches to Managing ADHD

Before considering medication, healthcare providers typically recommend behavioural therapy, particularly for children under six. According to Wolraich et al. (2019), the American Academy of Pediatrics (AAP) advises parent training in behaviour management as the first line of treatment for young children, as they respond well to structured interventions and support.

Behavioural interventions can include:

• Parent training programs: Educating parents on effective discipline strategies, positive reinforcement, and how to establish structured routines.
• Classroom management techniques: Teachers implementing clear rules, reward systems, and structured activities.
• Cognitive-Behavioural Therapy (CBT): Helping children develop coping mechanisms for impulsivity and inattention.
• Social skills training: Teaching children how to navigate peer interactions and improve social relationships.
• Mindfulness and relaxation techniques: Encouraging children to develop better self-awareness and emotional regulation.

While these interventions can be effective, they do not work for every child. Some children may continue to struggle despite these strategies, which leads parents to consider medication as an option.

When to Consider Medication

Deciding whether to use medication involves assessing the severity of the child’s symptoms and how much they interfere with daily functioning. Here are key indicators that medication may be beneficial:

1. Significant Impairment in Daily Life

If ADHD symptoms are severely affecting a child’s academic performance, relationships, or self-esteem despite consistent behavioural interventions, medication may be necessary. Signs of impairment include:

• Frequent disruptive behaviour in school.
• Difficulty completing homework or following instructions.
• Challenges in forming and maintaining friendships.
• High levels of frustration, anxiety, or emotional outbursts.
• Constant need for supervision to prevent risky behaviours.
• Emotional dysregulation leading to frequent mood swings.

2. Failure of Behavioural Therapy Alone

Behavioural interventions require consistency and time to show results. If, after several months, a child continues to struggle significantly, a combination of therapy and medication may be the best approach. Research has shown that multimodal treatment, combining medication and behavioural therapy, can be more effective than either approach alone (MTA Cooperative Group, 1999).

3. Age Considerations

For children under six, non-medication strategies are usually preferred. However, for children aged six and older, the AAP recommends a combination of medication and behavioural therapy when ADHD symptoms are moderate to severe (Wolraich et al., 2019). Adolescents may also benefit from medication, particularly when symptoms interfere with academic and social functioning (Banaschewski et al., 2017).

4. Comorbid Conditions

Children with ADHD often have coexisting conditions such as anxiety, depression, or learning disabilities. If these additional challenges make behavioural interventions less effective, medication may help regulate symptoms and improve a child’s overall well-being. ADHD often occurs alongside other conditions, and treating one may positively impact the other (Caye et al., 2016).

5. Safety Concerns

If a child’s impulsivity and hyperactivity put them at risk for injury (e.g., running into the street, engaging in risky behaviours), medication may help improve impulse control and reduce dangerous behaviours. Studies have found that stimulant medication can reduce accidents and injuries in children with ADHD (Ruiz-Goikoetxea et al., 2018).

Types of ADHD Medications

There are two main types of medications used to treat ADHD: stimulant and non-stimulant medications.

Stimulant Medications

Stimulants are the most commonly prescribed ADHD medications. They work by increasing dopamine and norepinephrine levels in the brain, helping children improve focus and impulse control. Studies show that stimulants are effective in 70-80% of children with ADHD (Faraone & Buitelaar, 2010).

Examples include:

• Methylphenidate-based medications (e.g., Ritalin, Concerta)
• Amphetamine-based medications (e.g., Adderall, Vyvanse)

Pros:

• Rapid onset of action (often within 30-60 minutes)
• Highly effective in reducing core ADHD symptoms
• Well-studied with decades of clinical use

Cons:

• Potential side effects such as loss of appetite, difficulty sleeping, and mood swings
• May require dosage adjustments over time
• Risk of misuse in older adolescents

Non-Stimulant Medications

Non-stimulants are an alternative for children who do not respond well to stimulants or have contraindications. These medications work by affecting norepinephrine levels in the brain.

Examples include:

• Atomoxetine (Strattera): Helps improve focus and impulse control, though it may take several weeks to show full effects.
• Guanfacine (Intuniv) and Clonidine (Kapvay): Often used for children with hyperactivity and impulsivity.

Pros:

• Lower risk of abuse or dependence
• Fewer sleep and appetite-related side effects
• Longer-lasting effects without the "crash" of stimulants

Cons:

• Slower onset of effectiveness (weeks rather than hours)
• May not be as effective as stimulants for some children

Potential Risks and Side Effects

While ADHD medications can be life-changing, they are not without risks. Common side effects include:

• Appetite suppression, leading to weight loss or poor weight gain.
• Sleep disturbances, particularly with stimulant medications.
• Mood changes, such as increased irritability or anxiety.
• Increased heart rate or blood pressure, though rare.

Long-term studies suggest that the benefits of medication outweigh the risks when used under medical supervision (Swanson et al., 2017).

Addressing Common Concerns

1. Fear of Overmedicating

Many parents worry about overmedicating their child. However, ADHD medications are carefully prescribed based on individual needs, and dosages are adjusted to find the lowest effective amount. Working with a pediatrician or psychiatrist ensures the right balance.

2. Stigma Around Medication

There is a lingering stigma that taking medication for ADHD means a child is "lazy" or "drugged." In reality, ADHD is a legitimate neurobiological condition, and medication is a tool that helps balance brain chemistry, allowing children to function more effectively.

3. Long-Term Effects

Research suggests that stimulant medications do not stunt growth or cause long-term harm when used appropriately. In fact, untreated ADHD can have far more serious consequences, including academic failure, substance abuse, and poor self-esteem (Biederman et al., 2019).

Final Thoughts: Making an Informed Decision

The decision to start ADHD medication should be made carefully, with input from parents, teachers, and healthcare professionals. Every child is different, and what works for one may not work for another. When considering medication, parents should weigh the potential benefits against the risks and continue to explore behavioural strategies that complement medical treatment.

Finding Focus Care Team

We are a group of nurse practitioners, continuous care specialists, creators, and writers, all committed to excellence in patient care and expertise in ADHD. We share content that illuminates aspects of ADHD and broader health care topics. Each article is medically verified and approved by the Finding Focus Care Team. You can contact us at Finding Focus Support if you have any questions!

References

Banaschewski, T., et al. (2017). Molecular genetics of attention-deficit/hyperactivity disorder: An overview. European Child & Adolescent Psychiatry, 26(1), 3-36. Link

Biederman, J., et al. (2019). Long-term outcomes of ADHD in adults: A review of controlled studies. The Journal of Clinical Psychiatry, 80(3), e1-e10. Link  

Caye, A., Rocha, T. B., Anselmi, L., Murray, J., Menezes, A. M., Barros, F. C., Gonçalves, H., Wehrmeister, F., Jensen, C. M., Steinhausen, H. C., Swanson, J. M., Kieling, C., & Rohde, L. A. (2016). Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome. JAMA psychiatry, 73(7), 705–712. Link

Faraone, S. V., & Buitelaar, J. K. (2010). Comparing the efficacy of stimulants for ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 204-213. Link

Polanczyk, G., et al. (2007). The worldwide prevalence of ADHD. American Journal of Psychiatry, 164(6), 942-948. Link

Swanson, J. M., Arnold, L. E., Molina, B. S. G., Sibley, M. H., Hechtman, L. T., Hinshaw, S. P., Abikoff, H. B., Stehli, A., Owens, E. B., Mitchell, J. T., Nichols, Q., Howard, A., Greenhill, L. L., Hoza, B., Newcorn, J. H., Jensen, P. S., Vitiello, B., Wigal, T., Epstein, J. N., Tamm, L., … MTA Cooperative Group (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. Journal of child psychology and psychiatry, and allied disciplines, 58(6), 663–678. Link