Choosing the best ADHD Medication for Children: A Parent’s Guide

A Few Highlights 

• ADHD is a neurodevelopmental condition that is marked by attention deficits, hyperactivity, impulsivity, and behavior issues. It most often begins in childhood. 
• ADHD isn’t caused by parenting or lack of effort on the part of the child. 
• Behavioral therapy and school support are typically the first-line treatments. 
• When therapy isn't enough to manage symptoms, ADHD medications may be added to the treatment plan. 
• There is not one specific ADHD medication that works best for every child. 
• Non-stimulants are a good option for many children and may be better tolerated than stimulants. These medications are non-habit-forming. They can work a bit slower. It may take 4 to 6 weeks for the full benefit.
• Ongoing monitoring and follow-up are essential for kids taking ADHD medications for long-term success.

Introduction to Pediatric ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder that affects attention, impulsivity, and behavior. 

It is characterized by ongoing problems with hyperactivity, inattention, and impulsivity that are more frequent or intense than what is typical for a person’s developmental level and age. 

This disorder also affects emotional regulation and self-control. ADHD also affects academic performance. Kids with ADHD often struggle in school compared to other students without ADHD. 

ADHD is one of the most common neurodevelopmental conditions in children. According to the Centers for Disease Control and Prevention (CDC), around 7 million children in the United States has been diagnosed with ADHD.

ADHD is not caused by poor parenting or laziness. It is a neurodevelopmental disorder that is typically diagnosed in childhood. It is strongly influenced by genetics and brain development, meaning children do not develop ADHD because of parenting style, diet, screen time, or lack of structure. While environmental factors (such as premature birth or early stress) can play a role, ADHD is not caused by anything a parent did or didn’t do.

ADHD subtypes 

There are three different ADHD subtypes. These include: 

• Predominantly Inattentive Presentation: This is sometimes referred to as “inattentive ADHD. Kids with this type have trouble paying attention, focusing, and following through on tasks. 
• Predominantly Hyperactive-Impulsive Presentation: This type is characterized by excessive movement or restlessness. A child with this subtype may constantly fidget and act without thinking. 
• Combined Presentation: Kids with this type have both symptoms of inattentive and hyperactive-impulsive ADHD. This is the most common subtype. 

ADHD treatment options 

For most kids with ADHD, behavioral therapy and school supports are the first step in treatment. These approaches help kids with ADHD improve behavior and manage symptoms. This can result in improvements both at home and at school. 

Child ADHD medication is considered when symptoms remain moderate to severe, even when therapy and classroom support are in place. There is no one “best” ADHD medication that works for every child. The right ADHD treatment plan depends on your child’s medical history, specific symptoms, and other factors. 

Finding the right treatment should always be personalized. It often takes time and may require adjustments along the way. 

First-line medication options

Many people associate ADHD treatment with stimulants. And, it is true that the first-line treatment for ADHD is stimulant medications, according to the American Academy of Child and Adolescent Psychiatry. 

Non-stimulant ADHD medications

At Emora Health, we focus on non‑stimulant ADHD treatment, which is a strong option for many kids with ADHD, especially those who want a gentler approach or who have had side effects from stimulant medications.  

How non-stimulant medications compare to stimulants

Non-stimulant meds work more gradually than stimulant medications. Stimulants act immediately on dopamine pathways, but non-stimulants work differently. Rather than working primarily on dopamine, they affect brain systems involved in impulse control, attention, and emotional regulation over time. For this reason, it may take several weeks for them to reach full effect. However, they can offer steadier symptom control for some children.

Non-stimulant medications for ADHD generally fall into two main categories:

• Norepinephrine reuptake inhibitors: These medications increase levels of norepinephrine. This is a brain chemical involved in attention, focus, and working memory.
• Alpha-2 adrenergic agonists: These medications act on receptors in the brain involved in impulse control, emotional reactivity, hyperactivity, and sleep.

FDA-approved ages 

The FDA-approved ages depend on the exact medication. Some ADHD medications are FDA-approved for kids as young as 6 years old. 

Onset

As stated above, the onset tends to be slower with non-stimulant medications. It may take up to six weeks for the full benefit. However, many parents and kids notice a difference within a couple of weeks. 

Dosing considerations

When it comes to ADHD medications, psychiatric prescribers typically start doses low and increase them slowly. Most ADHD non-stimulants are taken daily. This ensures consistent symptom coverage. The exact dose is based on a number of factors, including the child’s age and other co-occurring conditions, both mental and physical health-related. 

Non-stimulant ADHD medications

Non-stimulant medications have a lower risk of misuse compared to stimulant medications. 

They can be especially helpful for adolescents who have a history of substance misuse. 

Atomoxetine (Strattera) 

Atomoxetine is a non-stimulant medication that is approved for ADHD. It works by increasing levels of norepinephrine in the brain. This is a neurotransmitter involved in impulse control and attention. 

This medication can be especially helpful for kids and teens with ADHD who also have anxiety. However, like other non-stimulant medications, atomoxetine may take several weeks to reach full effectiveness. 

Atomoxetine in children can cause decreased appetite, stomach pain, and nausea, among other side effects. Some kids also experience mood changes. There is a rare but important black box warning about the increased risk of suicidal thoughts in children and adolescents taking atomoxetine. This risk is greatest when starting the medication. Therefore, close monitoring is essential. 

Viloxazine (Qelbree) 

Viloxazine (Qelbree) is a non-stimulant medication approved to treat Attention-Deficit/Hyperactivity Disorder in children ages 6 and older and adults. It also increases norepinephrine levels in the brain. This helps to reduce impulsivity and improve attention. It also helps lessen hyperactivity without the abuse potential associated with stimulant medications. 

As far as onset, clinical trials have shown improvements in symptoms within weeks. 

Like atomoxetine, viloxazine has an FDA boxed warning for increased risk of suicidal thoughts and behaviors in pediatric patients, so close monitoring is essential. 

The most common side effects reported in clinical studies include decreased appetite, sleepiness, nausea, irritability, and headache. 

Guanfacine (Intuniv) 

Guanfacine is a non‑stimulant ADHD medication that works by targeting the brain pathways that are involved in emotional regulation, impulse control, and attention. It’s available in both an immediate-release and extended release form. The extended-release is often preferred because it can be taken once a day. While appetite suppression can occur, it’s typically mild compared to that caused by stimulants. When used for ADHD, guanfacine can take about two to four weeks to work. 

Clonidine (Kapvay) 

Clonidine is a non-stimulant medication that is most often used to treat high blood pressure. It is also sometimes used for ADHD symptoms, like hyperactivity and impulsivity, as it affects the part of the brain that is involved with these symptoms. 

A benefit of this medication is that it can be used with other ADHD medications. It can also be helpful for kids who struggle with restlessness that interferes with sleep, as it is somewhat sedating.  

There are some drawbacks to consider, however. It lowers blood pressure and heart rate, so it can cause dizziness in some people who take it. This medication should not be abruptly stopped because it can cause blood pressure to rise quickly.  

Bupropion (Wellbutrin) 

Bupropion is an antidepressant that is sometimes used off-label to treat ADHD when it co-occurs with depression. It can improve impulsivity and attention while at the same time easing depressive symptoms. However, it’s important to note that Wellbutrin is not often used in children. It can be considered a third-line treatment for adolescents. 

Bupropion may also increase the risk of suicidal thoughts and behaviors in children and young adults under 24 years old. During the first several months of treatment, the risk is greatest. Therefore, close monitoring is imperative. 

Why Early Treatment Matters

Early treatment is very important for kids and teens with ADHD. It can have a significant impact on their social and academic functioning. It can also improve relationships, including with siblings and parents. 

According to 2022 data from the Centers for Disease Control and Prevention (CDC), almost 2 million kids and teens diagnosed with ADHD did not receive any kind of ADHD treatment in that year. That means that many kids are not getting support for ADHD symptoms. This can have a significant negative impact on their everyday lives. 

Many kids with ADHD also have other mental health and behavioral problems, like depression or anxiety. Not getting treatment for ADHD can worsen these conditions.

Untreated ADHD also increases the risk of developing new mental health issues. It is correlated with higher rates of depression, anxiety, and other mental health problems. 

Untreated ADHD also has a significant negative effect on academics. Children and adolescents with ADHD who are not treated or more likely to struggle with behavior problems at school. Poor academic performance and learning difficulties are also quite common. They are also more likely to drop out of school. 

When symptoms like inattention and impulsivity go untreated, children and teens are at a greater risk of accidental injuries from accidents and unsafe situations. For instance, a child with ADHD may act without thinking, running into the street without checking for cars first. In adolescents and teens, impulsivity can also increase risky behaviors like unsafe sex, substance abuse, and dangerous driving. 

On a positive note, ADHD treatment is associated with a reduced risk of both emotional and social problems. Kids and teens in treatment also have a reduced risk of substance abuse disorders. Treatment for this condition really makes a significant impact. 

The role of therapy with medication

When it comes to ADHD, the best outcome typically comes from a combined approach: therapy and medications. Behavioral therapy and parent training are a key part of treatment. 

Parent training helps parents develop positive behavior strategies, consistent routines, and skills for managing challenging behaviors. This helps kids function better both at home and at school. 

Executive functioning therapy focuses on helping kids learn how to stay organized, plan, start tasks, manage emotions, and follow through more independently. This can help them carry out tasks like cleaning their room and doing homework. 

Academic support is also important for kids with ADHD. Schools can help create interventions to improve academic and social functioning.  Examples include clear instructions and structured breaks. Organizational aids like visual schedules and labeled bins can also be helpful. 

How to choose the right medication

Choosing the right medication for ADHD is a process that involves parents and providers working closely together. There is no “perfect” medication that works for every child or adolescent. 

Choosing the right medication is based on multiple factors, including co-occurring conditions and other health conditions. The goal with medication management is to reduce the core ADHD symptoms like impulsivity and hyperactivity, and also to improve overall well-being and resilience over the long term. 

Side effects are an important concern that many parents have when it comes to medications, especially with stimulants. The largest study of ADHD that has been conducted found that there are many adverse effects associated with stimulant medication, including a loss of appetite and repetitive movements. In the study, some participants discontinued treatment because of the side effects. Fortunately, there is another option for kids and teens who have ADHD: non-stimulant medications. These tend to be better tolerated. 

4 Things to consider 

There are several things to take into consideration when it comes to medications. Here are some of them: 

1. ADHD subtype: The symptoms may respond differently to different medications depending on what type of ADHD your child has.  
2. Age: Some medications are only approved for specific age ranges. 
3. Co-occurring conditions: Such as depression, anxiety, or sleep problems. Some ADHD medications can help with symptoms of both disorders, as well as sleep issues. 
4. Family history: This is important because genetic factors can influence a person's response to certain medications. 

Consultation process with a psychiatric clinician

At Emora Health, the process of meeting with a psychiatric clinician is extremely easy. Your child will receive a comprehensive telehealth evaluation that covers medical history, symptoms, and treatment goals. Then, you will discuss treatment and medication options. 

Start a Psychiatric Medication Management Intake. 

Monitoring, titration, and long-term follow-up

Long-term monitoring and follow-up are all very important when it comes to ADHD medication management. 

ADHD medications are typically increased gradually rather than quickly. This process is called titration. It helps reduce side effects while providing relief from symptoms. During the titration process, attending regular follow-up visits every 2-4 weeks is critical. This allows providers to monitor behavior, symptoms, mood, and any concerns about side effects or other issues. They may also make dose adjustments during follow-ups. 

Long-term follow-up ensures that the treatment remains effective over time. It is the best for optimal symptom management. Long-term care is also important when it comes to tapering the medication. Typically, medication is continued for at least 9 months before tapering is considered under supervision.

Potential side effects and safety monitoring

When it comes to ADHD medications, it’s very important to keep all follow-up appointments for ongoing monitoring. Regular appointments can help detect side effects, such as changes in appetite and irregularities in blood pressure, early. 

During these visits, the provider will also typically assess suicidality and mood changes. This is especially important when starting treatment, as well as changing doses. It’s also something that is recommended by the  U.S. Food and Drug Administration. 

Personalized ADHD support at Emora 

At Emora Health, we integrate assessment, therapy, and pediatric psychiatry all on one convenient, virtual platform. This comprehensive approach to ADHD care ensures that your child gets the best possible treatment. You’ll have access to licensed therapists who specialize in ADHD treatment. You don’t have to worry about long waitlists, and many insurance plans are accepted. 

Therapy is tailored to your child’s needs and age. You’ll find useful interventions, like parent training, to reinforce skills your child learns in therapy. This helps support long-term resilience and growth.

Regular collaboration between therapists and psychiatric clinicians ensures that your child gets the best care. 

Get a Cost Estimate for Therapy, Medication & ADHD/Autism Testing today. 

Frequently asked questions

Are non-stimulants as effective as stimulants?

While stimulants have higher response rates in clinical trials, non-stimulants are better tolerated. Non-stimulants are effective. It's just important to remember that they take longer to work. 

Non-stimulants are generally safer compared to stimulants. Stimulants carry the risk of misuse, dependence, appetite issues, and cardiovascular issues. 

How long do non-stimulants take to work? 

Non-stimulants work gradually. They typically take between 2 to 6 weeks to work. In some cases, it may take up to 8 weeks to see the full effect. However, changes can sometimes be seen earlier, before attention improves. These may include better emotional regulation or distress tolerance.

It’s important to note that the slower onset does not mean that the medication is not working. It just means that it works more gradually. 

What are the best medications for ADHD in children?

There is not a single best medication for ADHD. What works best depends on the individual.  But some of the most prescribed options include guanfacine, atomoxetine, and viloxazine. These may have fewer side effects compared to stimulants, particularly regarding heart rate and appetite suppression.  

Do ADHD medications replace therapy?

No, the most effective treatment for ADHD is medications and therapy plus parent training. 

Disclaimer: It’s important to note that the information in this article is not one‑size‑fits‑all. It should not replace personalized care from a licensed clinician.