The type of treatment for ADHD, the choice of product, as well as its dosage and administration strategies are decisions which rely upon the doctor’s own opinion, judgment and knowledge. However, the decision to actually initiate the proposed treatment is the parent’s own, until the child can decide for himself. For these reasons, it is important for parents to talk openly with their doctor with regards to the types of available treatments, their benefits, their side effects as well as any issue involving the child’s overall health. Commonly reported side-effects are mainly related to a loss of appetite, but in rarer cases sleep disturbances, gastrointestinal inconveniences, heart palpitations or adverse behavioral changes (anxiety, negative thoughts, apathy) have also been known to arise.
Three major classes exist, including methylphenidate-based psychostimulants, amphetamine-based stimulants and non-stimulants. Below is a list of currently available ADHD medication in Canada.
Ritalin: Short-acting stimulant (3-4 hours) but also available in longer-acting, extended-release version known as Ritalin XR (6-8 hours). Though less prescribed these days, it still holds an important position in treatment choices, namely as a supplement or in cases where adverse events are reported with other products.
Biphentin: Long-acting stimulant (8-12 hours). Releases a larger initial dosage than its competitors, which makes it more effective in the morning than during the afternoon, thereby helping individuals become more alert during morning classes or workloads.
Concerta: Long-acting stimulant (8-12 hours). Gradual release of its dosage throughout the day and has the advantage of keeping attention levels stable in the afternoon.
Dexedrin: Short-action stimulant (3-4 hours) but also available in extended-release version (6-8 hours). Mainly prescribed to treat narcolepsy, but is also used as an ADHD treatment.
Adderall XR: Long-acting stimulant (10-12 hours). An Exception drug that is mainly prescribed when previous ADHD treatments have failed to show expected results, or have caused significant side-events.
Vyvanse: Long-acting stimulant (12-14 hours). Mainly prescribed in adolescents and adults, since its effectiveness is long enough to support the individual throughout the evening, after returning home. For example, allowing a person to remain efficient throughout evening-time studies or until the kids can be put to bed.
Strattera: Very long-acting medication (24 hours). A little less effective in improving attention when compared to stimulants, but has the benefit of also addressing anxiety. More difficult to administer than stimulants because its effects will not be noticeable before 2 to 4 weeks, and because halting the medication requires a gradual decrease of its dosage over a few weeks’ time.
Intuniv: Very long-acting medication (24 hours). Used mainly to minimize behavioural symptoms such as anxiety, restlessness, impulsivity, anger or opposition. Sometimes used as a supplement to other ADHD treatments, or other difficulties altogether. Like Strattera, it requires more diligence because of its delayed onset and the need to gradually reduce the dose before its withdrawal.
For more information on available ADHD treatments, please refer to the CADDRA Guide of pharmacological treatments for ADHD in Quebec.