background About 80% of children diagnosed with ADHD show a favorable response to stimulant medication. The compliance in different age groups can vary, especially depending on the attitude of the parents, the mode of action of the medication (efficacy, long-acting, adverse events) and of the psycho -ducation and demystification of the medication by the doctor.
aim To comment on the efficacy and safety of ADHD medication.
method The comments draw from empirical evidence and the clinical experience of a pediatrician.
results In many children the dose must be adjusted several times in the beginning of the treatment. In puberty the dose must be adjusted again. In puberty the acceptance of the medication especially depends on the autonomy of the youngster. If he or she becomes aware of therapeutic benefits of the medication, and is stimulated to finetune the dose depending on the context and demands to be met, the compliance will be very much promoted. Side-effects must lead to changes in dose or medication immediately. Regular contact via text messages or e-mail will enhance the compliance. If in puberty the dose is not adjusted regularly, the end point will be like the MTA study: no more effect than ‘care as usual’.
Long-term safety aspects that bother patients and clinicians comprise concerns about growth of the body and about the maturation of the brain, development of substance use disorders (SUD), or changes in mood or character.
conclusion In general practice, concerns about long-term efficacy and safety are not clinically relevant problems. It is important that that there are regular contacts between the doctor and the patient and his or her parents, that treatment continuation is discussed regularly, and that patients and their parents are very well informed about potential adverse events. It is important to balance the potential side-effects versus the risk of the disorder, when untreated.