Areas › Focus, starting, and ADHD › Treatment and medication
Long acting does not automatically suit everybody. Some people genuinely do better on shorter doses, and it is worth saying so rather than assuming the newer option must be right.
There is a folk belief that a person's own chemistry takes over in the afternoon once the medicine wears off, and the research does not support it. What appears to happen is a return to the baseline they started from, not a step down below it. That matters, because the belief is used to justify leaving the afternoon and evening uncovered, which are often the hours where homework, family and driving all live. Some children take a small later dose and sleep perfectly well.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
God has set a due measure for everything (Quran 65:3). Finding the right measure for one person is patient, particular work.
وَيَرۡزُقۡهُ مِنۡ حَيۡثُ لَا يَحۡتَسِبُۚ وَمَن يَتَوَكَّلۡ عَلَى ٱللَّهِ فَهُوَ حَسۡبُهُۥٓۚ إِنَّ ٱللَّهَ بَٰلِغُ أَمۡرِهِۦۚ قَدۡ جَعَلَ ٱللَّهُ لِكُلِّ شَيۡءࣲ قَدۡرࣰ ا
and will provide for them from an unexpected source; God will be enough for those who put their trust in Him. God achieves His purpose; God has set a due measure for everything
Qur’an 65:3read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A crossover trial compared once daily extended release methylphenidate with the same drug given three times a day, in a laboratory setting and in ordinary life, testing whether a formulation that avoids a dose at school does the job as well. The interesting part is that the comparison had to be run at all. Which formulation suits a person is an empirical question, and it is settled by watching what happens rather than by reasoning about it.
William E. Pelham; Elizabeth M. Gnagy; Lisa Burrows-MacLean; Andy Williams; Gregory A. Fabiano; Sean M. Morrisey (2001). Once-a-Day Concerta Methylphenidate Versus Three-Times-Daily Methylphenidate in Laboratory and Natural Settings. PEDIATRICS doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
How long a dose lasts and how it suits someone is a question about their body, which is why the answer differs from person to person.
When not to
Any change to timing or dose goes through the prescriber, since this is not something to adjust at home.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
A child can be almost trouble free with a grandparent who has all afternoon for them, and impossible in a class of twenty five. Same child, same condition, very different demand.
Said plainly, because it should be: medication is the most effective treatment for ADHD, and by a good margin. Everything else in this area is something you add to that decision, not something that replaces it.
Programmes built on crossing the midline or on balance and inner ear work do not appear to beat ordinary exercise. If movement is what you are after, movement is available free.