A fter your child is diagnosed with attention deficit hyperactivity disorder (ADHD), their pediatrician and other healthcare providers will recommend behavioral approaches that can help boost your child’s self-control and self-esteem. Next, they may recommend medication.
There are two classes of medication approved by the Food and Drug Administration (FDA) that can lessen ADHD symptoms: stimulants and nonstimulants. Both can help your child function better academically, at home, and among their family and peers.
Stimulant medications are the most commonly prescribed treatments and often prescribed first. But if your child doesn’t tolerate stimulants well, they may be a candidate for nonstimulants.
Here’s a look at how nonstimulants work inside the body.
In 2002 the FDA approved the first nonstimulant for kids with ADHD, and a handful of others followed. Now, a new drug has entered the mix: Viloxazine (Qelbree), a selective norepinephrine reuptake inhibitor (SNRI), also called a serotonin norepinephrine modulating agent (SNMA), which was approved by the FDA in April 2021 for use in children.
This guide can help you understand nonstimulants and when they might be worth considering for your child’s ADHD symptoms.
Stimulant or Nonstimulant? How ADHD Treatment Decisions Are Made
Stimulants have been used to treat ADHD in children since the first drug was approved almost 60 years ago, and they continue to be a standard treatment today. According to the Centers for Disease Control and Prevention (CDC), 70 to 80 percent of the approximately 6 million kids and teens diagnosed with ADHD get some relief from stimulant medications, which usually contain methylphenidate (Ritalin, Concerta) or amphetamine (Adderall).
It may seem strange to give your child something with a reputation for revving things up rather than calming things down, but stimulants are often paradoxically effective.
That said, stimulants are controlled substances and carry a risk of addiction and abuse. This, along with other potential side effects, can be a deal breaker for some families. Other possible reactions include tics, anxiety, weight loss, and sleeplessness.
Many experts stress that ADHD treatment has to be individualized and work for your child’s situation right now, at this point in their life, with the recognition that it should be revisited several times as your child develops and issues rise or fall in importance.
“Number one,” says Jeffrey Newcorn, MD, director of the Division of Child and Adolescent Psychiatry at the Mount Sinai Medical Center in New York City, “What aspects of the condition are causing the greatest problem for the child? Try to get a treatment that homes in on that.”
Since as many as 6 in 10 children with ADHD have another behavioral, mental, or emotional health condition, such as depression or anxiety, according to the CDC, it’s extra important to adapt to changes in your child’s needs over time. Put another way: While certain stimulants or nonstimulants might work now, that could change.
A team of experts, including your child’s teacher, guidance counselor, doctor, psychiatrist, or therapist, can help you monitor your child’s condition and manage their treatment. (And if you don’t have a care team like this, consider assembling one!)
8 Essential Facts About Nonstimulants for ADHD
1. Healthcare providers usually prescribe stimulants for ADHD first.
“Stimulants have been around for a long time and, in some ways, are considered the gold standard for treatment in ADHD,” says Dr. Newcorn. If initial treatment isn’t effective or tolerable, your child’s doctor may adjust the dosage, add another medication to the regimen, or switch medications entirely.
2. The FDA has approved four nonstimulant medications for ADHD in children ages 6 to 17.
The first nonstimulant to be approved by the FDA for ADHD was atomoxetine (Strattera) in 2002, followed by clonidine (Kapvay) in 2010, guanfacine (Intuniv) in 2009, and most recently, viloxazine (Qelbree) in 2021.
3. The effects are not immediate.
Nonstimulants need to be taken for several weeks or months before noticing a difference. Once your child has adjusted to this medication, you can expect each dose to be effective for 24 hours. The initial waiting period can be an adjustment for parents whose children previously took a stimulant, which tends to affect ADHD symptoms much faster but also wears off more quickly.
4. … but each dose is effective for longer.
Stimulants last up to 16 hours, with maximal effects limited to within 7 to 8 hours, even with controlled release, sustained release, and extended release formulations. The effect of most nonstimulants lasts longer. They are taken at regular times either once or twice a day.
5. Unlike stimulants, nonstimulants are not a controlled substance.
Nonstimulants are not controlled medications, which means they’re not as closely regulated by the U.S. government, making it less cumbersome to refill your prescription. They’re also less likely than stimulants to make anxiety or insomnia worse.
6. But they aren’t risk free.
Everyone reacts differently, but nonstimulant medications’ possible side effects include fatigue and tiredness, stomach upset, dry mouth, nausea, dizziness, anxiety, and sleep problems, such as insomnia. SNRIs (atomoxetine, viloxazine) may increase the risk of suicidal thoughts, so the FDA warns healthcare providers to carefully monitor patients for these kinds of thoughts in the first few months on these medications and after every dose increase. In rare cases, nonstimulants can cause damage to the liver.
7. Most people find them easy to use.
- Atomoxetine (Strattera) is a capsule that’s taken either once a day (in the morning) or twice a day (in the morning and late afternoon or evening). Kids can take it with or without food.
- Clonidine ER (Kapvay) is a tablet and can also be taken once or twice a day, with or without food.
- Viloxazine (Qelbree) is a once-a-day capsule that can be swallowed whole with or without food. As a perk for children who can’t swallow pills, the capsules can be broken open and the medicine sprinkled on 1 to 3 teaspoons of applesauce or pudding.
- Guanfacine ER (Intuniv) is also taken just once a day, either in the morning or evening — preferably without high-fat food, which can make the medication release too fast and worsen side effects.
8. Clonidine ER (Kapvay) and Guanfacine ER (Intuniv) are blood pressure medications that can positively affect ADHD.
These drugs aren’t considered as effective for ADHD as stimulants or the SNRI nonstimulants but are an option if other medications fail to provide relief. They’re generally more tolerable in terms of side effects for people who have psychiatric disorders, heart disease, insomnia, or certain other conditions. Children taking these should have their heart rate and blood pressure periodically checked. They may also feel extra tired.
6 FAQs About Nonstimulants, Answered
Is My Child a Candidate for Nonstimulants?
Next Steps for Your Child’s ADHD Treatment Plan
When building a treatment strategy, you’ll need to take into consideration your child’s unique needs and circumstances: their age, whether they’ve tried stimulant medications already, and if they have other issues they struggle with, such as depression or anxiety.
What’s more, medication should represent just one of the multiple ways you help your child manage at home, at school, and in their relationships. Skills training, and family and individual counseling can be valuable, as can understanding why and how ADHD affects your child and involving your child’s teachers and coaches.
Here are some questions and angles to consider for your child’s next doctor’s visit.
- How is my child doing with managing school, friendships, and life at home? What’s the most difficult thing for them right now?
- What does my child say about how they are doing?
- Has anything changed for my child recently?
- Is it possible ADHD symptoms are lessening and we can back off treatment a bit? Or have the symptoms increased?
- Do I have a good handle on behavior modification strategies (cognitive behavioral therapy) and how they can help?
- Is there a strong team of counselors, doctors, teachers, and others involved in making things go as smoothly as possible for my child?
- How much nutritious food, sleep, and daily exercise is my child getting? Is there room for improvement?
- Is my child experiencing side effects from this medication, such as tics, weight issues, or other reactions? If so, are they significant enough to ask about other medications?
- Could a different set of ADHD medications also help (or worsen) other problems my child has, such as depression, anxiety, or being on the autism spectrum?
- Has my child or teen (especially those ages 18 to 24) ever talked about suicide or expressed suicidal thoughts?
- Have other family members struggled with abuse and addiction, and does this mean I should more seriously consider nonstimulants for my child?
- Should I consider getting a second opinion about my child’s treatment, possibly even through a telehealth visit with a provider at another medical practice that may be more familiar with other ADHD medications?
Do you think it might be time for your child to switch to a nonstimulant or add one to their ADHD treatment plan? If so, consider saving these conversation starters and bringing them to your next appointment.
- Could a nonstimulant help my child, given that they struggle with ADHD symptoms? (List your child’s symptoms here.)
- How long would it likely take my child to transition to nonstimulants and get off stimulants entirely?
- How long will my child be on this medication before we’re likely to notice a difference?
- Should my child take the medication at any particular time? For example, if my child is having the most trouble with ADHD during the school day, should they take the medication in the morning?
- How often should I check back with you on my child’s progress after starting a nonstimulant?
- My child is going to be a teenager soon. Do certain medications work better in this age group?
- Is it common to need an adjustment in the dosage of a nonstimulant over time?
- What should I do if I notice my child feeling more tired than usual after starting this medication? Will this side effect likely lessen over time?
- Is it important that my child take the medication with food (or milk)?
- My child is depressed. Are nonstimulants worth the risk, given that they appear to increase suicidal thoughts in some people?
- My child takes some dietary supplements. Could these lessen the effectiveness of or interfere with this medication?
- Is there anything else I should know about this nonstimulant before my child starts taking it?