Considerations for Medication Recommendation

Clinicians, parents, and teachers have a responsibility to provide treatment that is in the best interest of the child. Thus, prior to the prescription of stimulant medication for the child with ADHD, a number of issues should be considered, such as:

• The child’s age. Children younger than 5 years of age have a lower response to these medications and, therefore, are not recommended; this is especially true for children under the age of 3 years.
• Symptom duration and severity. The greater the behavioral disruption, the more likely they may be prescribed medications to help control their behavior. Especially among boys, the more severe the ADHD symptoms, the greater the probability of a positive response to these medications.
• Potential risk of injury to the child due to the presenting symptoms. For obvious reasons, medication may be prescribed for children who are at-risk for hurting themselves due to inattentiveness or hyperactivity.
• Efficacy of prior treatment. Non-pharmacological interventions may be attempted prior to recommending a prescription of medication. This is especially true if the symptoms are relatively mild. An evaluation for medication eligibility may be suggested if the non-pharmacological approaches have had limited success in controlling the ADHD symptoms.
• Possibility of tics or Tourette syndrome. One of the potential side effects of these medications is motor tics or Tourette’s syndrome. It is also possible that the medication may unmask an underlying condition.
• Presence of internalizing disorder. If a child with ADHD has a co-morbid internalizing disorder such as an anxiety disorder, the likelihood of a positive response to the medication is decreased. Thus, consideration should be given to alternative treatments.