ADHD, usually first evident in childhood, is characterized by excessive motor activity, difficulty in sustaining attention, and impulsiveness. A variety of stimulant drugs have been utilized in the treatment of ADHD, and they are particularly indicated in moderate-to-severe cases. Methylphenidate is effective in children with ADHD and is the most common intervention; treatment may start with a dose of 5 mg in the morning and at lunch, increasing gradually over a period of weeks depending on the response as judged by parents, teachers, and the clinician. The total daily dose generally should not exceed 60 mg. Methylphenidate has a short duration of action; thus, most children require 2-3 doses/day, with the timing individualized for effect. Methylphenidate, dextroamphetamine, and amphetamine probably have similar efficacy in ADHD. pemoline appears to be less effective, although like sustained release preparations of methylphenidate (ritalin sr, concerta, metadate) and amphetamine (adderal xr), pemoline may be used once daily in children and adults. potential adverse effects of these medications include insomnia, abdominal pain, anorexia, and weight loss that may be associated with suppression of growth in children. Minor symptoms may be transient or may respond to adjustment of dosage or administration of the drug with meals.
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