Areas › Focus, starting, and ADHD › Medication and how it works
The growth effect is usually small: something like a couple of pounds and a centimetre or two less than expected in the first year or two, with most children catching up afterwards. Knowing the size of it helps, because both blank reassurance and quiet dread are worse than the actual number.
Height and weight get plotted at review appointments for exactly this reason, so ask to see the chart rather than carrying a vague worry between visits. For a child who is already very small for their age it becomes a fairer conversation, and a break over the holidays or a move to a non stimulant, which affects growth much less, are both reasonable things to raise.
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). A known and bounded effect is easier to live with than an unnamed fear.
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
The long term picture is not fully settled. A review of chronic methylphenidate exposure during childhood weighs the documented benefit against unresolved questions about effects on the developing brain, which is a fair summary of where things stand: the short term effects are well described and the long term ones much less so. That is an argument for measuring and reviewing rather than for alarm.
Loureiro-Vieira S, Costa VM, de Lourdes Bastos M, Carvalho F, Capela JP. (2017). Methylphenidate effects in the young brain: friend or foe?. International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
Eating less for a while slows the rate of gain, and the rate usually picks up again afterwards.
When not to
If a child is falling away from their growth curve, that is for the prescriber to act on rather than something to watch and hope about.
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
There are three families of medicine here: the stimulants, the agents that work on noradrenaline alone, and the alpha-2 drugs that began as blood pressure treatments. Three routes rather than three brands of one thing.
The question that usually matters most is not which molecule but how many hours it covers. A medicine that has worn off by four in the afternoon leaves the hardest stretch of the day uncovered.
Doing the behavioural work alongside a medicine can mean managing on less of it. That matters most for the side effects that follow the size of the dose.