If your child has been diagnosed with ADHD and is currently on ADHD medication, an important part of your child’s treatment is follow up. During ADHD follow up visits, we make sure that the medications are working for the ADHD symptoms and that side effects are not posing problems. Side effects of these medications are common, but generally not serious.
The most common side effect of stimulant medication is appetite suppression. Because of this, following your child’s weight over time is important. Because most stimulant medications that we give last 8 to 12 hours, a child needs to have meals that correspond to time when he or she will be hungry. For instance, give breakfast before taking the stimulant medication in the mornings. In addition to eating a good supper, encourage your child to eat a fourth meal in the later evenings. Have food available for this time. This will make up for the food that your child doesn’t eat at lunch because of the effects of the ADHD medication. Still try to have your child eat lunch. But know however, that their appetite will be diminished at lunchtime due to the presence of the ADHD medication.
Another important aspect of ADHD treatment with stimulant medication is dose titration. Getting the dose right for your child is crucial. Stimulant medications are not dosed according to weight as other medications are, but are dosed according to how to your child responds to them. The initial dose of most ADHD stimulant medications will not be high enough to control ADHD behavior for most kids with the disorder. The dose must be gradually increased until it is effective at controlling the ADHD symptoms without intolerable side effects. There are three possible scenarios in dosing a stimulant medication for a child with ADHD:
- The child is on too low of a dose. This means that the child will likely have few side effects of the medication, but also the ADHD symptoms will be poorly controlled. ADHD symptoms were listed on the ADHD page. You can refer to this list. Controlling ADHD symptoms requires that the dose of the medication be high enough. The dose needs to be increased.
- The child is on just the right dose. This means that the ADHD symptoms will be well controlled and side effects should be minimal. However, appetite suppression is common on doses that are effective.
- The child is on too much stimulant medication. This means that the ADHD symptoms will be well controlled, but side effects will be greater. The two most common side effects of too much medication are: a socially withdrawn state (a zombie like stare) and emotional lability (gets mad or cries easily). The dose should be diminished to correct this situation. Contact your physician regarding the proper course of action.
Because ADHD is caused by a neuro-transmitter (dopamine) imbalance, medications are needed for this condition. The treatment is generally a stimulant medication, although non-stimulant medications are available. Please know that the stimulant medications used to treat ADHD are Class II narcotics controlled by the US Drug Enforcement Agency. Misuse of Class II narcotics is a felony, carrying the risk of prison time. For this reason, there are several rules related to prescribing stimulants that are required by the DEA:
- Prescriptions must be written and signed. They cannot be phoned in or sent electronically to the pharmacy. Therefore, they can only be written by our physicians while our office is open. We can and will not prescribe ADHD medications after our office is closed.
- Prescriptions cannot be refilled. By DEA regulations, we can write three prescriptions at one time. We generally do this at ADHD follow up visits.
- Pills should be kept in their containers. Carrying ADHD medications out of their containers is not wise and may get you arrested as these medications are only legal if they are in their pharmacy issued, labeled pill containers.
- Do not sell these medications. It is against the law.
- Do not take someone else’s ADHD medications. This is also against the law.
- Don’t lose your prescriptions. We will be very hesitant to re-write lost prescriptions as diversion to illegal use is common with these medications.
Once a medication has worn off for the day, the effects of that medication immediately diminish and resolve. Yesterday’s ADHD medication is not present in your child’s body today. Also, it’s effects do not linger from yesterday into today. In addition, ADHD stimulant medications begin working a few minutes after they are taken, generally being quite effective 30 to 60 minutes after being taken.
If your child has just started a new stimulant medication, a one month follow up is mandatory per the Arkansas Medical Board. We will write your second stimulant prescription at this visit. We cannot write another until this requirement is met.
Another important aspect of ADHD follow up is monitoring your child’s progress on the stimulant medication. Follow up Vanderbilt forms are required for this. Please download the following documents and fill them out prior to a follow up visit for ADHD to help us in following your child with ADHD.