Monitoring side effects and the potential for misuse of ADHD drug treatment in children, young people and adults

All medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD

• height and weight:
  • in people taking medication for ADHD:
    • height should be measured every 6 months in children and young people
    • measure weight every 3 months in children 10 years and under
    • measure weight at 3 and 6 months after starting treatment in children over 10 years and young people, and every 6 months thereafter, or more often if concerns arise
    • measure weight every 6 months in adults
    • plot height and weight of children and young people on a growth chart and ensure review by the healthcare professional responsible for treat
    • if weight loss is a clinical concern, consider the following strategies:
      • taking medication either with or after food, rather than before meals
      • taking additional meals or snacks early in the morning or late in the evening when stimulant effects have worn off
      • obtaining dietary advice
      • consuming high-calorie foods of good nutritional value
      • taking a planned break from treatment
      • changing medication
    • if a child or young person's height over time is significantly affected by medication (that is, they have not met the height expected for their age), consider a planned break in treatment over school holidays to allow 'catch-up' growth
    • consider monitoring BMI of adults with ADHD if there has been weight change as a result of their treatment, and changing the medication if weight change persists
      
      
• cardiovascular monitoring:
  • heart rate and blood pressure should be monitored; and compare with the normal range for age before and after each dose change and every 6months
  • if person taking ADHD medication has sustained resting tachycardia (more than 120 beats per minute), arrhythmia or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on 2 occasions, reduce their dose and refer them to a paediatric hypertension specialist or adult physician
  • if a person taking guanfacine has sustained orthostatic hypotension or fainting episodes, reduce their dose or switch to another ADHD medication
    
    
• tics
  • if a person taking stimulants develops tics, think about whether:
    • the tics are related to the stimulant (tics naturally wax and wane) and
    • the impairment associated with the tics outweighs the benefits of ADHD treatment
  • if tics are stimulant related, reduce the stimulant dose, or consider changing to guanfacine (in children aged 5 years and over and young people only), atomoxetine, clonidine, or stopping medication
    
    
• sexual dysfunction
  • monitor young people and adults with ADHD for sexual dysfunction (that is, erectile and ejaculatory dysfunction) as potential adverse effects of atomoxetine
    
    
• seizures
  • if a person with ADHD develops new seizures or a worsening of existing seizures
    • review their ADHD medication and stop any medication that might be contributing to the seizures
    • after investigation, cautiously reintroduce ADHD medication if it is unlikely to be the cause of the seizures
      
      
• sleep
  • changes in sleep pattern (for example, with a sleep diary) should be monitored and adjust medication accordingly
• worsening behaviour
  • the behavioural response to medication should be monitored, and if behaviour worsens adjust medication and review the diagnosis.
    
    

Reference:

• (1) NICE (March 2018). Attention deficit hyperactivity disorder Diagnosis and management of ADHD in children, young people and adults