Dr. K

DEAR DOCTOR K: My daughter has ADHD. I have heard conflicting reports about ADHD medication for kids. Please tell me, is it safe and does it work?

DEAR READER: ADHD stands for "attention deficit hyperactivity disorder." Children with ADHD have trouble paying attention and are impulsive and hyperactive. These symptoms can get in their way and make it harder for them to function at school and at home. ADHD also interferes with a child's ability to form and keep friendships.

Methylphenidate is the most commonly prescribed drug for ADHD. It's known by many brand names, including Ritalin, Concerta and Quillivant. It has been used for over 50 years to treat ADHD, and studies have found it to be effective in decreasing symptoms.

Despite its long history, the first comprehensive, systematic review of the benefits and risks of this drug was not published until 2015.

The researchers reviewed hundreds of studies that examined the effects of methylphenidate for ADHD. They found that the drug did improve children's performance in the classroom. And parents reported a better quality of life for the family when their children were taking medication. On the other hand, there was some evidence that it increased the risk of sleep problems and decreased appetite.

So what does this mean for parents trying to decide whether their child should take ADHD medication?

First, parents can take comfort in the fact that these medications often work. They reduce problems with attention, impulsivity and hyperactivity. This often improves a family's quality of life at home and leads to better overall behavior at school.

Parents can also rest assured that methylphenidate is unlikely to cause serious, long-term problems. About one in four children who take the drug may have minor and short-lived problems with sleep and appetite. These issues may improve as a child adjusts to the medication. And knowing that these issues might be a problem can help parents anticipate possible solutions. For example, if appetite becomes a problem, you can give your child a big breakfast before taking the medication. Or work with your child's doctor to lower his or her dose if sleep is an issue.

In addition, parents should be aware that medication isn't the only treatment option. For example, cognitive behavioral therapy (CBT) can also help children with ADHD. Relaxation training and social skills training are other treatment options.

Because I'm not a pediatrician, I haven't seen kids with ADHD in my practice. But I sure have seen their parents. And one common misconception that parents have about ADHD -- and about other "psychological" problems -- is that they represent a character disorder. They think the kids have a weakness, one they should be able to overcome with willpower and discipline.

In my opinion, that's the wrong way to think about it. I believe that ADHD is caused by a chemical imbalance in the brain. While CBT, relaxation training and social skills training help kids function, they probably don't change brain chemistry.

The bottom line? Find a doctor who understands and commonly treats ADHD. When medication is prescribed correctly by a knowledgeable physician, the positives outweigh the negatives.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115