ADHD treatment for children: support, medication and what to expect

When parents look up ADHD treatment for their child, the question underneath is usually simpler: what will help my child, and does it have to mean medication? The honest answer is that treatment for ADHD in children is a combination of understanding, practical changes at home and school, support for parents and, for some children, medication. Medication is never the whole plan, and it is not the only option.

This guide explains how NICE, which sets the standards for the NHS in England, approaches treatment, so you know what to expect from any specialist, including us.

Treatment for ADHD in children starts with understanding

After a diagnosis, NICE says the doctor should talk with you and your child about what ADHD means for your child's life: the strengths it can bring, the challenges, and the help available. Families should be offered clear information and support focused on ADHD. This can be quite short, even one or two sessions, and covers what ADHD is, parenting strategies and, with your consent, contact with school.

If you are offered a parenting programme, it is not a criticism. NICE says plainly that recommending parent training does not mean bad parenting. Children with ADHD need more from the adults around them than most children do, and these programmes help with that. ADHD is not caused by parenting.

How to help a child with ADHD at home

Small, steady changes often help more than any single big one. Drawing on NICE and NHS advice:

• make time for warm, positive moments together, not only correction
• keep rules clear and consistent, and give the day a predictable structure
• give instructions one at a time, simply and in a calm voice
• break tasks such as homework into short slots with breaks in between
• use a to-do list or picture timetable your child can see
• praise effort, and use rewards your child cares about
• make room for physical activity your child enjoys, regular sleep and regular, balanced meals

On diet, NICE does not recommend cutting out additives or giving fatty acid supplements as a general treatment. If you notice a clear link between particular foods and behaviour, keep a food and drink diary and talk it through with the doctor. Our guide to parenting a child with ADHD has more ideas.

Support at school

NICE uses the term "environmental modifications" for practical changes that reduce the impact of ADHD on daily life. At school these might include where your child sits, fewer distractions, shorter periods of focus with movement breaks, written instructions alongside spoken ones, and good use of a teaching assistant. These changes should be tried and reviewed before medication is considered. Our guide to ADHD and school explains how to work with the SENCO.

When is ADHD medication considered?

For children aged 5 and over, NICE says medication should only be offered if ADHD symptoms are still causing persistent, significant difficulty in at least one area of life after changes at home and school have been put in place and reviewed. Your family should also have talked through the benefits, risks and alternatives, and your child should have had a health check first.

For children under 5, NICE says medication should not be offered without a second opinion from a specialist service. BZ Clinic sees children from age 5.

The decision is yours to make with the doctor, and you can revisit it later. The NHS notes that not everyone with ADHD needs or wants medicine. For other children, medication makes school, friendships and family life noticeably easier. Neither choice is a failure.

Types of ADHD medication for children

ADHD medicines fall into two groups: stimulants and non-stimulants.

Stimulants

Methylphenidate is NICE's first choice of medicine for children aged 5 and over and young people with ADHD. It comes as standard tablets, which may be taken up to three times a day, and slow-release forms, usually taken once in the morning, which can mean no dose is needed at school.

If methylphenidate has been tried for 6 weeks at a suitable dose without enough benefit, NICE suggests considering lisdexamfetamine. Dexamfetamine may be considered for a child who responds to lisdexamfetamine but cannot manage its longer effect.

Stimulants are controlled drugs, so prescriptions follow extra rules and you may be asked for ID when collecting them.

Non-stimulants

Atomoxetine and guanfacine are options if stimulants are not tolerated, or have not helped after proper trials. They usually take longer to reach their full effect.

How ADHD medication is started and monitored

ADHD medication should only be started by a specialist with training in ADHD. Before starting, the doctor checks your child's physical health, including height, weight, pulse and blood pressure, and asks about any heart problems in your child or the family. A heart tracing (ECG) is not needed routinely, only if something in the history or examination suggests it.

The dose is then adjusted step by step, a process called titration. During this time, parents and teachers usually fill in short rating forms so the doctor can see what is changing, and your child comes back to clinic for face-to-face reviews while the dose is adjusted. The aim is the dose that helps most, with side effects your child can manage.

Once your child is on medication, NICE recommends:

• height measured every 6 months and plotted on a growth chart
• weight checked every 3 months in children aged 10 and under, and in older children at 3 and 6 months after starting, then every 6 months
• heart rate and blood pressure checked before and after every dose change, and every 6 months
• a specialist review at least once a year, including whether medication is still needed

Routine blood tests are not needed unless there is a particular reason.

Common side effects

All medicines can have side effects, and they vary from child to child. With methylphenidate, the more common ones include reduced appetite, trouble getting to sleep, headaches, stomach ache, dry mouth and feeling sick. Some weight loss in the first few months is common and is usually regained. It can cause a small rise in heart rate and blood pressure, which is why these are checked. Taken for more than a year, it can slow growth in some children, which the NHS says affects fewer than 1 in 10, and this is why height is measured.

Less commonly, children can have changes in mood, tics or a fast or irregular heartbeat. Tell the doctor about any change that worries you. If your child has chest pain, a fit, or signs of a serious allergic reaction, call 999.

Many side effects can be eased by adjusting the dose or timing, giving the medicine with or after food, or changing to a different medicine.

Shared care with your GP

Once your child is stable on medication, NICE recommends that prescribing and monitoring move to the GP under a shared care arrangement. At BZ Clinic, once medication is stable, usually after around 3 to 4 months, we ask your child's NHS GP to take over prescribing under shared care. If the GP will not, a private GP practice in West Byfleet that we work with can take over. We do not provide long-term prescriptions for children. A short medication review costs £270, a clinic review £370, and a prescription £40, or £30 if collected in clinic.

Will my child always need ADHD medication?

Not necessarily. NICE recommends a specialist review at least once a year to decide with you and your child whether to continue, and planned trial breaks or dose reductions when the balance of benefit and harm suggests it. The decision is revisited over time, never made once and left.

If your child has not been assessed yet, our guide to how to get a child tested for ADHD explains the steps, and you can read about a private ADHD assessment for your child at BZ Clinic. If your child already has a diagnosis and you would like to talk about treatment, see our page on an existing ADHD diagnosis.

Questions parents ask