Treating Newly Diagnosed Pediatric ADHD With Stimulants

Stimulants are the most effective medications for the treatment of pediatric ADHD, says Anthony L. Rostain, MD, MA. In this video, Dr Rostain answers the question: "When a patient is newly diagnosed with attention-deficit/hyperactivity disorder (ADHD), is it better to begin treatment with a stimulant or a nonstimulant?" 

Dr Rostain is the Chief and Chair of the Department of Psychiatry at Copper University, Camden, New Jersey. He is also professor of psychiatry and pediatrics at Cooper Medical School of Rowan University.

Read the transcript:

Far and away, stimulants are the most effective medications for both children, adolescents, and adults with ADHD.

We generally start with stimulant medication. The nice thing about stimulants is that you can see the effects fairly quickly. You can titrate the dose to optimal effect. You can monitor tolerability, all within a very short timeframe.

The important thing to remember, though, with anybody who's started on a stimulant, is that there aren't any contraindications to using stimulants. In children, any concerns about cardiac problems, growth suppression… all of this be factored into the decision making.

With adults, concerns about whether or not there's going to be appropriate treatment adherence, concerns about non-medical use or diversion, stimulant misuse.

For the most part, I would say stimulants are safe and are the preferred first-line because they have the strongest evidence in their favor and because the effect sizes are very, very high, so the chances for success are greater.

That being said, there are reasons to start with non-stimulants. For example, prior experience with a stimulant that caused side effects or personal preferences that some individuals just don't like the idea of taking something that they have...It's the on and off effects. They want something that works around the clock.

When we think about 24-hour coverage and improvements that begin early in the morning and last well up until bedtime, if that's what's the growing concern of the individual, we might start with a non-stimulant instead of a stimulant.