Medication for ADHD follows a defined order rather than being a single choice, and the dose is arrived at over weeks rather than prescribed correctly on the first attempt.
This page explains how that process works. It is not advice about what to take, no dose appears anywhere on it, and nothing here should be used to start, stop or change a prescription. That is a conversation with a prescriber who knows your history.
It is not the first thing offered to everyone
For children under five, NICE guidance recommends an ADHD-focused group parent-training programme as the first-line offer, and states that medication should not be offered to that age group without a second specialist opinion from a service with expertise in young children. [nice-ng87-adhd-medication]
That is close to the opposite of what most parents arrive expecting, and it is worth knowing before the appointment rather than hearing it as a refusal during one.
For children of five and over, for young people and for adults, medication has a defined place, and it sits alongside information and support rather than instead of them. The ADHD hub covers what the condition involves, and our guide to ADHD in children covers what happens before any of this, at assessment.
There is an order, not a menu
Guidance for children of five and over and for young people sets out a sequence. [nice-ng87-adhd-medication]
Methylphenidate is the first-line pharmacological treatment, in either a short-acting or a long-acting form.
Lisdexamfetamine is considered where a six-week trial of methylphenidate at an adequate dose has not produced enough benefit.
Atomoxetine or guanfacine are offered where the first two cannot be tolerated.
The six-week detail is the one worth carrying into an appointment. A medication is not judged to have failed after a fortnight, and the trial is expected to be given a fair run at an adequate dose before moving on. Adults follow their own pathway, and which of these applies to any individual is a specialist decision rather than something to work out in advance.
A schematic of the process described in this article and in the guidance cited. Not measured data, and not a guide to any individual's treatment.
Almost every early disappointment sits in the gap between those two views.
Titration, and why the first dose is not the answer
Titration means starting low and adjusting upwards in steps, assessing the effect and any unwanted effects at each one, until you reach the point of most benefit for fewest costs.
It is slow on purpose. Each change needs enough time to be judged, and judging it needs information from more than the person taking it, which is why school or work reports get asked for again.
The practical consequence is that the opening dose is a starting point, not a trial. People frequently conclude that medication does not work for them on the basis of a first week that was never meant to be conclusive, and stop before the process has begun.
Treatment is also monitored rather than simply issued. For children that includes keeping track of growth, and blood pressure and pulse are checked. Report anything new promptly instead of waiting for a scheduled appointment, and do not stop suddenly without speaking to the prescriber.
Questions worth taking to the appointment
Tick anything you have not yet had answered. This is a preparation prompt rather than a test, and it produces no diagnosis or recommendation.
0 of 8 ticked
The second and third are the ones that prevent early quitting, because agreeing in advance what improvement would look like turns a vague impression into something you can both assess. The seventh is the one most often skipped: guidance places medication alongside support rather than instead of it, and the support has to be asked for.
Appointments are short and it is normal to leave having covered less than you meant to. Written questions get answered far more often than remembered ones.
Nothing here was outstanding. If the difficulty is that assessment has not happened yet, our guide to ADHD in children covers what that process involves.
No screener on this site assesses ADHD or has anything to say about medication. The hub lists what we do cover.
What medication does not do
It treats symptoms while it is being taken. It does not install any of the skills that years of untreated difficulty prevented somebody from building.
A person who has never had a working system for deadlines, keys, appointments and admin does not acquire one in the first fortnight of treatment. What frequently changes is that those systems become learnable, because the attention needed to build them is available for the first time.
This is also why the other conditions in the picture matter. Mood and anxiety disorders are among the most common alongside adult ADHD, and where more than one is present, guidance is that the most impairing is generally treated first. [katzman-2017-adhd-medication] Our guide to ADHD or anxiety covers how the two get confused in both directions.
When to seek help
Speak to your prescriber, not to the internet, about anything to do with your own or your child’s medication.
Contact them promptly rather than waiting for the next appointment if new physical symptoms appear, if mood changes noticeably after starting or changing a medication, if sleep or appetite change substantially, or if a child’s growth appears to have slowed.
Do not stop abruptly on your own. If you want to come off something, that is a legitimate conversation to have and it is safer to have it than to act on it.
Go urgently, the same day, if you or your child develop thoughts of self-harm or of not wanting to be alive.
How MyFreud can help
Titration runs on being able to answer whether this week was better than the last one, which is exactly the question memory answers badly. MyFreud gives you daily mood tracking that takes seconds, so what you bring to a review is a record rather than an impression formed on the day.
Download MyFreud and start today: App Store or Google Play.