Medicines for ADHD in children

Methylphenidate is the preferred first choice for ADHD

• Methylphenidate is the preferred first choice of medicine for ADHD in children. Methylphenidate comes in a variety of tablets and capsules. It may take some time for your healthcare provider and you to find the most effective dose and timing for your child.
• Dexamfetamine, lisdexamfetamine or atomoxetine are usually prescribed if tamariki are unable to take methylphenidate, if it hasn't worked well to improve their symptoms or there are supply issues.
  
  

ADHD medicines aren’t suitable for all children

• Some medicines may not be safe for children with certain medical conditions, such as heart problems, epilepsy, tic disorders, or some mental health conditions.
• Your child’s growth, sleep, appetite, heart rate, and blood pressure need to be monitored while taking ADHD medicines.
• ADHD medicines can interact with other medicines your child may be taking, including medicines or supplements you can buy over the counter so this must be carefully checked.
• Your child’s healthcare provider will carry out a full assessment, discuss possible risks and benefits, and recommend the most appropriate treatment or alternatives if needed.

Stimulant medicines (methylphenidate, dexamfetamine and lisdexamfetamine) are more complex than other medicines because of special prescribing, dispensing and funding rules.

Stimulant medicines are controlled drugs

• In Aotearoa New Zealand methylphenidate, dexamfetamine and lisdexamfetamine are classed as controlled drugs which means they're carefully monitored and regulated to make sure they're used safely. This is because they affect the brain and can be addictive or misused if not taken properly. Because of this, prescribers need to follow special rules when prescribing them and pharmacies must keep records when they dispense them.
• You can get a prescription with repeats that cover up to 3 months, depending on your prescriber’s decision, but pharmacies can only dispense 30-day supplies at a time.
• You need to pick up the medicine within 7 days of it being prescribed, or the prescription may expire or require reauthorisation.
  
  

Stimulant medicines are funded under a Special Authority

• In Aotearoa New Zealand methylphenidate, dexamfetamine and lisdexamfetamine are funded under a Special Authority for people who meet the criteria.
• The term 'Special Authority' refers to a specific kind of approval needed for funding certain subsidised medicines by Pharmac.
• Pharmac is the government agency in New Zealand that decides which medicines and medical devices are publicly funded. Pharmac uses this process to ensure medicines are funded for people who will benefit most from the treatment. Read more about Special Authority.

Who can apply? Applications for Special Authority for stimulant medicines used to treat ADHD for children aged 17 years or under can be made by specialists such as a paediatrician or psychiatrist or by a nurse practitioner working in the field of child or adolescent mental health. 

Does the Special Authority expire? For stimulant medicines used to treat ADHD, the Special Authority doesn't expire so the approval is valid for the patient’s lifetime. Ongoing prescriptions for these medicines can be written either by a specialist, or by a GP or nurse practitioner on the recommendation of a specialist or initial prescriber.

Medicines for ADHD can help children manage symptoms and make daily life easier. They don't cure ADHD but work best when used together with other supports, such as routines, behaviour strategies, and healthy lifestyle habits.

Treatment is guided by a healthcare professional who has experience working with children with ADHD. Support may include:

• learning about ADHD and understanding how your child’s brain works
• therapy, such as cognitive behavioural therapy (CBT), to build helpful skills
• support to develop social skills and positive relationships
• help with any emotional, behavioural, or learning difficulties linked to ADHD
• treatment for other conditions that may occur alongside ADHD
• support for parents, caregivers, and family members to encourage and guide the child in positive ways.

Read more about ADHD in children.

What to expect when your child starts ADHD medicines

When your child starts ADHD medicine, their healthcare provider will check how well it’s working and whether there are any side effects. This usually includes:

• Watching how symptoms change, such as concentration, focus, restlessness, mood, and sleep.
• Advice to keep a diary or log, noting how your child feels, their energy, and any side effects. This helps spot patterns and understand what works best.
• Checking their health including their sleep patterns, weight, growth and blood pressure.
• Adjusting the medicine, for example the dose or type may change to get the best results.
• Reviewing other medicines. This includes any new medicine, even over-the-counter ones, which should be checked to make sure they're safe with ADHD medicine.
  
  

How long will my child take medicine?

ADHD medicine is usually taken every day. Some children take it for a few months, while others take it for years. Your healthcare provider will help decide what’s right for your child. Sometimes they may suggest a planned break to see how your child manages without it. Never start, stop, or change medicine on your own.

Tip: Keeping a diary helps you and your child see patterns in concentration, mood, sleep, energy, and side effects. This makes it easier for the healthcare provider to make the best decisions.