Stimulant Medications
How methylphenidate and amphetamines work, why "stimulant" can produce calm focus, and what to expect from treatment.
Important to know:
Not "stimulating" the brain
Despite the name, stimulants don't make children more hyperactive. They help the brain's "control centre" work better.
Filtering out distractions
They help the brain focus on what matters and tune out background noise and interruptions.
Making boring tasks doable
By boosting dopamine (the "motivation chemical"), they make it easier to start and complete uninteresting tasks.
Better impulse control
By boosting noradrenaline, they help children think before acting and stay focused for longer.
Types of stimulant medication
| Name | Release | Duration |
|---|---|---|
| Ritalin | Immediate release | 3-4 hours |
| Concerta XL | Extended release | 10-12 hours |
| Equasym XL | Extended release | 8 hours |
| Medikinet XL | Extended release | 8 hours |
| Xaggitin XL | Extended release | 10-12 hours |
Most commonly prescribed first. Different brands have different release profiles.
| Name | Release | Duration |
|---|---|---|
| Elvanse (Lisdexamfetamine) | Slowly activated by the body | 10-14 hours |
| Dexamfetamine | Immediate release | 4-6 hours |
| Amfexa | Immediate release | 4-6 hours |
Often tried if methylphenidate doesn't work well. Elvanse is most common amphetamine in UK.
Release types
Duration: 3-4 hours
Pros:
- • Can fine-tune timing
- • Wears off quickly if problem
Cons:
- • Multiple doses per day
- • Wear-off peaks and troughs
Often used to find right dose initially, or for specific times.
Duration: 8-14 hours depending on formulation
Pros:
- • Once daily dosing
- • Smoother effect
- • No school dose needed
Cons:
- • Less flexible
- • Takes longer to wear off if problems
Most common for maintenance treatment.
Common side effects
Reduced appetite
Very commonManagement: Give medication with or after breakfast. Large meal when it wears off. High-calorie snacks.
Contact clinician if: Significant weight loss. Monitor growth.
Sleep difficulties
CommonManagement: Take medication earlier. Good sleep hygiene. May need shorter-acting formulation.
Contact clinician if: Persistent insomnia affecting function.
Headaches
Common initiallyManagement: Often settle. Stay hydrated. Paracetamol if needed.
Contact clinician if: Severe or persistent.
Mood changes
VariableManagement: Note timing - may be wear-off effect (rebound). Adjust timing or formulation.
Contact clinician if: Persistent low mood, irritability, or personality change.
Stomach aches
Common initiallyManagement: Take with food. Usually settles.
Contact clinician if: Persistent or severe.
Increased heart rate
CommonManagement: Usually mild and not concerning. Monitored at appointments.
Contact clinician if: Palpitations, chest pain, dizziness.
How to tell if it's working
- ✓Improved focus on tasks
- ✓Better able to start and complete work
- ✓Less impulsive
- ✓Calmer, not sedated
- ✓Improved emotional regulation
- ✓Better social interactions
- ✓Child feels more in control
- ✓Teachers notice improvement
- No noticeable improvement in focus/impulsivity
- Side effects outweigh benefits
- Only works for very short time
- Child feels "zombie-like" or flat
- Significant personality change
- Symptoms worse not better
- 1Start at a low dose
- 2Monitor effects and side effects
- 3Gradually increase dose if needed
- 4Find optimal dose (best effect, manageable side effects)
- 5May need to try different medications
This process takes weeks to months. Patience is important.
"Stimulant" is a misnomer for how these medications work in ADHD. They improve prefrontal cortex function, leading to better focus and often a calmer, more regulated state - not hyperactivity.
Finding the right medication and dose takes time. The goal is the best balance of symptom improvement with manageable side effects for your child.