Are ADHD Stimulants Working?

A common ADHD treatment is stimulant medication. Methylphenidate is popular, with trade names of Ritalin, Concerta, Daytrana, and Metadate. An amphetamine salt (trade name Adderall) is also used quite a bit.

Dosages are typically prescribed based on a child’s size. It is not uncommon for these dosages to be too high. Parents may notice a trade-off in symptoms, for example, when their child’s attention is improved but he is more physically agitated. This is one clue that the dosage may not be appropriate. Or, an “over-medicated” child might be sluggish, less creative, and (while medications are active in his system) lose his spunky personality. In other words, too much medication can smother the best parts of ADHD.

Stimulant medications take effect quickly. Within about 30 minutes, medication impacts thinking and behavior. Measuring the impact of stimulant medication has historically been difficult. Parents are left to their own observations, the hard-to-read self reports of their child, and input from teachers. With detailed behavior observations (such as how long a medication takes to act on the child, and what happens as the medication wears off), some gains can be made.

But, there is a better way to determine if a stimulant medication is effective. It’s called the Test of Variables of Attention (TOVA). It’s simple, short (about 20 minutes), and accurate. This test can be repeated time and again. A recommended use of TOVA is to compare a child’s “baseline” (performance without medication) against a medication trial. For example, baseline results can be compared for how a child does with 5mg methylphenidate. Since results are ready as soon as the test is finished, physicians and parents have real-time information to consider dosage or prescription adjustments.

A common finding from the TOVA test is that dosages are too high–meaning that unnecessary side effects can be reduced with the lessening of medication, while positive effects can remain. Test results can be very helpful for prescribing doctors. They also give parents clear directions on next steps in treatment and help with peace of mind.

The TOVA is also used as a standard part of ADHD assessments. From 2003 to 2007, there was a 22% increase in kids with parent-reported ADHD, according to the CDC. Research continues to find higher rates of ADHD. There is no single cause of ADHD, but some factors are known to contribute to it.