For school-age children:

It depends how you define ADHD. According to the most recent NICE guidelines (2018), if you look at the core symptoms of inattention, hyperactivity and impulsivity, medication is a first line treatment after initial psychoeducation (information about ADHD). This should be given alongside a parent training intervention if the child is also diagnosed with oppositional defiant disorder, conduct disorder or oppositional behaviour.

These are the UK-licensed medications.

Stimulant brand names (scientific name):

Ritalin, Medikinet, Equasym, Concerta (Methylphenidate)

Elvanse (Lisdexamphetamine)

Non-stimulants:

Stratera (Atomoxetine)

Intuniv (Guanfacine extended release/ XR)

Overall, ADHD medication is very effective. In general, stimulants are more effective than non-stimulants.

To establish effectiveness of medication, you look at the effect size from studies where children have taken medication and are compared with children who have taken a placebo. An effect size of 0-0.3 is small. The results may be statistically significant but they are not really clinically relevant. An effect size of 0.3-0.6 is moderate. And then an effect size of 0.8 or higher is very effective.

Studies have shown methylphenidate has an effect size of 0.8. Amphetamines are even higher around 1.0. So these are very effective.

Non-stimulants show lower effect sizes. Atomoxetine and Guanfacine XR are around 0.5-0.6 and so are moderately effective.

ADHD medication changes the concentration of some neurotransmitters in the brain which allow communication across neurons, meaning messages are better able to travel around the brain. The medication works in several areas of the brain including the prefrontal cortex (important for self-control, decision-making and other executive functions).

Stimulants mainly increase dopamine and also noradrenaline and induce the delivery of dopamine into the synaptic gap. This double mechanism may explain why they are more powerful than non-stimulants. Due to the way stimulants work, there is the potential of addiction which is an important factor to consider.

Non-stimulants, like atomoxetine, do have some cross-over with stimulants in the areas of the brain where they work, and mainly increase noradrenaline. We know that they are alpha-2 andranergic agonsists(!) which can improve working memory performance, but it is not yet clear exactly how they work.

No.

In general, in 100 children with ADHD, you might expect:

- approx. 40 would respond equally well to methylphenidate and amphetamine

- around 25 would respond better to amphetamine and 15 would respond better with methylphenidate

- approx. 15 would not respond to stimulants but 7 or 8 of these would respond to atomoxetine

So, ADHD medication doesn't work for every child but it does work for a good percentage.

No, it is a symptomatic treatment which means that when the medication is in the system, symptoms decrease. When the medication wears off, the symptoms come back.

Similarly, the medication tends to normalise how the brain functions while it is in the system, but not as the medication wears off.

So, the medication needs to be taken on a regular basis.

The two most common ones are sleep onset delay and decreased appetite. This is usually temporary and gets better over time but in some cases, the side effects do not go away.

Less common side effects are abdominal pain, headache, increased irratibility (although this is more common in children who have other disorders as well).

In rare cases, there have been reports of suicidal ideation, and in extremely rare cases, liver problems.

When you have established a diagnosis which means there are symptoms but also impairments in daily functioning, clinicians look to treat the degree of severity in discussion with the family. Some families prefer to try alternative options, e.g. establishing new routines at home and school, but if families have come through CAMHS, they have usually been on a long waiting list and don't want to wait any longer to start treatment.

At first, clinicians prescribe and review after one month to assess how the medication is working and if there are any intolerable side effects. Adjustments are made until the right dose has been achieved. This may take a few weeks or months. Once symptoms are stabilised, there is a review every 6-12 months to ensure levels of medication are effective and side effects are tolerable. This review would include measuring weight, height and blood pressure.

This is tricky to answer in a general way but some things to consider are that the teacher has been seeing the child with ADHD over the years and is now seeing a child on medication, so there will be some changes e.g. less hyperactivity, less impulsivity.

But if the change is particularly marked and raises concerns, it could be a result of an additional disorder or the medication dosage being too high. Clinicians are aiming to reduce the impairing symptoms of ADHD in order to bring the child into the normal range of functioning.

It is important to know the source of the information you read on the internet because some of it can be misleading.

I always recommend looking at the NHS website because the information is grounded in solid evidence.

There are also some good parent and foundation charities such as ADDISS and the ADHD Foundation which have high quality, educational material.