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There are 5 different types of drugs which may be used to treat ADHD or comorbid conditions. Two classes of drugs, namely stimulants and nonstimulants, are first-line treatments for ADHD, and three classes of drugs, namely anti-depressants, antihypertensives, and mood stabilizers may be used alone or combined with stimulants to treat symptoms of ADHD and comorbid conditions.

Stimulants

Stimulants are approved by the Food and Drug Administration (FDA) for the treatment of ADHD in children and are the most commonly used for the past 50 years. They are also used on an "off-label" basis to treat adult ADHD. This class of medication increases the levels of three neurotransmitters: dopamine, norepinephrine, and serotonin which together improve symptoms of ADHD. They are considered by the American Academy of Child and Adolescent Psychiatry (AACAP) to be the first-line treatment of ADHD. Approximately 1 out of every 10 children with ADHD does not respond to stimulants. Specific stimulants for the treatment of ADHD include:

• Methylphenidate (Ritalin)
• Dextroamphetamine (Adderall)
• Lisdexamfetamine dimesylate (Vyvanse)

Methylphenidate and dextroamphetamine have been used for many years in the treatment of ADHD and they have been shown in numerous clinical trials to be safe and effective in managing inattention, impulsivity, and hyperactivity in school-age children. One of these trials was a large study undertaken by the National Institute of Health in 1999, called the Multimodal Treatment Study of ADHD. It included 597 children with ADHD ages 7-9 who were treated with stimulants and followed for 24 months. Data showed that 68-80% of the children treated with either stimulant exhibited improvement to the point that, at the end of the study, they no longer met the diagnostic criteria for ADHD. According to the American Academy of Pediatrics, 80% of children with ADHD will respond to one of the two stimulant drugs.

In 2006, the National Institute of Mental Health sponsored a multisite, long-term study to determine the safety and efficacy of treating preschoolers (ages 3-5) who were diagnosed with ADHD with methylphenidate. Data showed that methylphenidate was effective at low doses for preschoolers although not as effective as for children ages 6 and above. In addition, preschoolers were more sensitive to side effects of methylphenidate so they need to be carefully monitored while taking the medication. As with school age taking methylphenidate for ADHD, the study found that the growth rate of preschoolers slowed while they were taking the medication. Since this is a new study, there is not any data yet regarding the effect of the medication on long-term growth rates. Studies investigating this important issue are underway.

Each of these stimulants has proven to be similar in efficacy however, some physicians claim that there are more frequent mild side-effects seen with dextroamphetamine. Both medications are available as short, medium, or long term formulations which can be taken every 12 hours. The long term formulations are called: Concerta, Metadate CD, Ritalin LA (methylphenidate), and Dexedrine Spansules or Adderall XR (dextroamphetamine). In April of 2006, the Food and Drug Administration (FDA) approved a new delivery system of methylphenidate in a skin-patch form, called Daytrana for children between the ages of 6-12. Low doses of the patch yield good response and are well tolerated. Typically, the medication is started at a low dose and increased until an effective dose is reached that does not cause side-effects. Once an effective dose is reached (generally over 2-4 weeks) follow up visits may take place every 3-4 months to monitor the efficacy of the medication and check the child's height, weight, pulse, and blood pressure.