Nonstimulant Options for Treating Childhood ADHD

 ADHD Weekly, December 1, 2022

Most people who have heard of ADHD have also heard of the stimulant medication options to include in treatment plans. Frequently, when a parent declines either to have a child evaluated for ADHD or to begin a treatment plan after a diagnosis, it is because of a hesitancy to include stimulant medications.

There are many reasons parents or caregivers hesitate to include stimulant medications in treatment, and they know their children’s health needs best. Some express concerns about how the medication works in the body, possible side-effects, the risk for abuse or misuse, family medical history, or personal desire not to employ this class of medication. Parents should discuss their concerns with their child’s ADHD specialist and primary care provider to find a treatment solution that is best for their child.

Less often discussed, though, are the nonstimulant medications that can be employed in ADHD treatment. These medications, on average, have fewer side effects and health risks. Many families are more comfortable with them as a treatment choice, because they don’t carry a risk of abuse or misuse and are not regulated at a higher, more restrictive, medication schedule.

Non-stimulant choices for families

“I think it’s very important to have another, nonstimulant option,” says Andrew Cutler, MD, a clinical professor of psychiatry at SUNY Upstate Medical University. Dr. Cutler was a clinical investigator for a newer nonstimulant medication that entered the market recently. “That’s really one of the biggest unmet needs in the treatment of ADHD.”

Nonstimulant medications can take up to eight weeks to be fully effective in controlling ADHD symptoms. Like their counterparts, they work best when combined with a behavioral treatment approach. Often parents will also participate in parent training for ADHD, especially when children are in elementary school. Behavioral treatment plans often include academic accommodations to help children manage their symptoms at school and be successful students.

This class of medication draws from several different types of medications. Some of these were designed to address ADHD symptoms. Others were originally formulated to treat other health conditions and then found to help reduce ADHD symptoms.

Nonstimulant medications work by encouraging brain cells to be more capable of accepting neurotransmitters—the messenger hormones of the brain. The effect is the brain is better able to pay attention and organization the information it receives—and that leads to a reduction in ADHD symptoms.

Why pick a nonstimulant medication?

Parents have the final say when it comes to creating a child’s treatment plan. Prescribers will talk with parents about treatment options and answer any questions they may have. Most prescribers will suggest starting with a stimulant medication but will offer nonstimulants when either the child’s health requires it or the parents request a different approach.

Often parents will approve or request a type of medication based on their own experiences, either with ADHD medications or from other lived experiences. The majority of families are seeking a multimodal approach to treatment, where medication is one of several treatment interventions in a plan.

Medication choice also relies on family background, which can include more than medical history. Cultural perspectives, regional location, and access to medical care for ADHD strongly influence the choices families make.

Choosing the right medication for your child

“Stimulants are not the ‘end-all, be-all’ solution for ADHD,” says Samantha Roseberry, PharmD, BCPP, an inpatient clinical pharmacy practitioner. “Nonstimulant medications provide hope for those who are not interested in or unable to take a stimulant. It is essential to discuss all treatment options and risks and benefits with your health care provider, as with any condition.”

Parents and those in parenting roles should work closely with medical providers to find the medication that works best for the individual child and meets the child’s and family’s needs.

Learn more about medication options:

Join the discussion: What types of medication or treatment approaches have worked well for your family?