People with ADHD should not be offered drugs called antipsychotic drugs to treat their symptoms.
The specialist should offer to give the person:
a full physical and mental health assessment, including discussion with the person about their views and preferences for treatment
clear instructions about taking the medication.
For children and young people, this will depend on a number of things, such as:
In children and young people, methylphenidate should normally be offered if they do not have any other serious mental health problems or if they also have conduct disorder. Methylphenidate or atomoxetine should normally be used if the person also has tics, Tourette's syndrome or anxiety, or if they are misusing stimulants. If methylphenidate has been tried and does not help, atomoxetine should be offered.
The type of methylphenidate that should be offered to children and young people is usually long lasting (sometimes called 'modified release') so that they do not have to take another dose during school hours. Tablets that work straight away ('immediate release') may be considered if children and young people need to take their medication at different times of the day.
Methylphenidate is usually the first treatment offered to adults with ADHD.
Adults with ADHD, partners, parents or carers and teachers should be asked to keep a record of changes in symptoms and behaviour when medication is started or the dose is changed. A specialist should contact them regularly to check on how things are going.
Healthcare professionals should also check for side effects regularly. These could include:
weight loss or not reaching an expected height in children and young people
an increase in heart rate or blood pressure
serious changes in mental state (such as seeing or hearing things that are not there)
the appearance of tics.
If there are side effects, the dose of medication may need to be reduced, stopped or changed.
For all people taking medication for ADHD, their weight should be measured 3 months and 6 months into the treatment, and every 6 months after that. In children and young people, their height should be measured every 6 months. A healthcare professional may suggest stopping the medication over the school holidays to allow the child's growth to 'catch up'.
If any person on medication for ADHD loses weight, then healthcare professionals should advise that the drug is taken with or after food rather than before meals. Additional meals or snacks in the early morning or late evening may help. The healthcare professional may seek dietary advice and suggest high‑calorie foods of good nutritional value. If weight loss continues, a different drug may need to be considered.
All people taking medication for ADHD should have their heart rate and blood pressure checked every 3 months and before and after any change in dose.
Healthcare professionals should warn that some people (especially young adults) taking atomoxetine may feel more agitated or irritable than usual, have thoughts about suicide, self‑harm, and experience unusual changes in behaviour, especially during the first few months of treatment or after a change in dose. Parents or carers should be asked to report these effects to their healthcare professional. Healthcare professionals should warn people (of any age) taking atomoxetine, and their parents and carers if applicable, about the rare possibility of liver damage (the signs of this are stomach pain, nausea, dark urine or jaundice).
Healthcare professionals should ask older boys and men about any sexual problems as a result of taking atomoxetine. They should also ask girls and women whether the medication has had any effect on their periods.
Parents and teachers should be advised that stimulant medication can be misused. The risk may increase as the child or young person gets older or if their circumstances change.
Visual reminders to take medication regularly (such as clocks, pill boxes and notes on calendars or fridges) can be helpful. Taking medication should be part of a daily routine (for example, before meals or after brushing teeth). Having a positive attitude about taking medication, and giving appropriate praise to a child, may also help. If taking medication regularly is difficult, the healthcare professional may suggest attending a support group.
If methylphenidate or atomoxetine (together with courses for parents and psychological therapy for the child or young person) do not help children and young people with ADHD, healthcare professionals should review the treatment so far. The dose of the medication may then be increased or dexamfetamine or another drug may be offered. Other psychological treatments may also be offered.
In adults, if methylphenidate does not help, either atomoxetine or dexamfetamine may be tried instead. Psychological help may also be offered.
Medication should be continued for as long as it is helpful. This should be reviewed every year after a full assessment, and at least every year in children and young people. Healthcare professionals should work with the person to find a pattern of treatment that works best. This may include periods when medication is not taken.