Pediatrics · Topic 14 of 32
ADHD & Stimulant Medications
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ADHD & Stimulant Medications
Inattention, hyperactivity-impulsivity or both, starting before age 12. Stimulants are first-line Schedule II drugs: morning doses, vital signs and growth checks, secure storage.
What it is
Symptoms before age 12, in two or more settings
DSM-5 needs symptoms for at least 6 months: six or more in a domain up to age 16, five or more from age 17. ADHD persists into adulthood in at least one-third of children; screen for learning disorders, anxiety, depression and conduct problems.
What you'll see
Often mistaken for laziness or misbehavior
Red flags
Rare stimulant effects to report: priapism, pale or blue numb fingers or toes, new tics, hallucinations or new manic symptoms.
Treatment
Parent training in behavior management first under age 6
From age 6: medication plus behavior therapy and school supportsSchedule II — boxed warning for abuse, misuse and addiction
Morning dosing; none within 6 hours of bedtimeWatch closely for suicidal thoughts, especially the first month
Report signs of liver injuryTaper — never stop abruptly
Sedation, hypotension, bradycardiaDosing details
Nursing priorities
Stimulant or non-stimulant?
Different drugs, different dangers to watch
| Stimulants | Atomoxetine | Guanfacine / clonidine | |
|---|---|---|---|
| Controlled? | Yes — Schedule II | No | No |
| Key danger | Abuse, misuse, addiction (boxed warning) | Suicidal thoughts in children and teens (boxed warning) | Rebound hypertension if stopped suddenly |
| Watch for | BP and pulse rise, appetite loss, insomnia, slowed growth | Liver injury: jaundice, dark urine, itching | Sedation, low BP, slow pulse |
| Stopping | Drug holidays only as the prescriber plans | Stopped for jaundice | Taper — never stop abruptly |
Teach your patient
Stimulants go in the morning — a late dose steals sleep. Every visit: BP, pulse, height and weight. Atomoxetine: watch for suicidal thoughts. Guanfacine and clonidine: taper, never stop.
Sources · Attention Deficit Hyperactivity Disorder (StatPearls) · Psychiatric-Mental Health Nursing 23.4 ADHD (OpenStax) · Pharmacology for Nurses 13.5 CNS Stimulants and Nonstimulants (OpenStax) · ADHD Clinical Practice Guideline 2019 (AAP) · Treatment of ADHD (CDC) · Ritalin label (DailyMed) · Vyvanse label (DailyMed) · Adderall label (DailyMed) · Strattera label (DailyMed) · Intuniv label (DailyMed) · Follow your facility's protocol for controlled-substance storage and counts.
ADHD & Stimulant Medications
Attention-deficit/hyperactivity disorder, or ADHD, is a neurodevelopmental disorder of inattention, hyperactivity-impulsivity, or both, with symptoms that start before age 12 and show up in at least two settings, such as home and school. It comes in three presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Children under 6 start with parent training in behavior management; from age 6, medication is paired with behavior therapy and classroom supports. Structure helps every child: a steady routine, clear simple directions, a quiet space for tasks, and plenty of praise. Stimulants such as methylphenidate, mixed amphetamine salts and lisdexamfetamine are first-line, and they are Schedule II drugs. Give them in the morning so the patient can sleep, check blood pressure, heart rate, height and weight, and teach families to lock them up and never share them. Atomoxetine, a non-stimulant, carries a boxed warning for suicidal thoughts in young people and can injure the liver. Guanfacine and clonidine are tapered, never stopped suddenly, because blood pressure rebounds.
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