Areas › Focus, starting, and ADHD › Medication and how it works
Finding the dose is a search rather than a calculation. It goes up in small steps until either the effect you want turns up, or the side effects get annoying enough that you come back down a step and settle there.
There is no way to work the right dose out from body weight or from how bad things look, which surprises people who expect medicine to be more exact than this. Expect a few weeks of small changes with somebody watching the effect at home and at school. Brief weekly notes, on what got better and what bothered you, make the search shorter than it would otherwise be.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
'where there is hardship there is also ease' (Quran 94:5). The settling in period is genuinely hard, and it is not the whole story.
فَإِنَّ مَعَ ٱلۡعُسۡرِ يُسۡرًا
So truly where there is hardship there is also ease
Qur’an 94:5read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
This is what treatment looks like outside a trial. A one year open label study of adults in routine practice found real benefit from stimulant and non stimulant medication, alongside a great deal of dose adjustment and a substantial burden of side effects. It was open label with no placebo group, so the size of the benefit is soft, though the picture of continual adjustment is an honest description of the work involved.
Fredriksen M, Dahl AA, Martinsen EW, Klungsøyr O, Haavik J, Peleikis DE. (2014). Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): an open-label prospective study of time in treatment, dose, side-effects and comorbidity.. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
People differ so widely in how they respond that the only reliable way to find the dose is to try and watch.
When not to
Dose changes belong with the prescriber, and chest pain, fainting or a severe change in mood means stopping and getting advice at once.
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 who barely touches lunch may still eat a normal amount across the day. Look at breakfast and dinner before concluding that they are not eating.
If the first medicine disappoints, that is information about the first medicine. Plenty of people who get nothing from one class do well on another.
People often refuse one name and accept another when both contain the same drug. Ritalin and Concerta are both methylphenidate, delivered differently.