ADHD Medication Titration Process: what to Expect

Titration is a big word that means working with your doctor to get your child’s medication just right.

The goal is to find the dose (or amount) of medicine that controls your child's symptoms of attention deficit hyperactivity disorder (ADHD) with the fewest side effects. Like any medicine, ADHD drugs can have side effects. And they don't work in exactly the same way for every child.

It can take time to find the right balance -- sometimes many weeks. But it is worth it. The doctor will usually tell you to give your child slightly more medicine every 1 to 3 weeks. They will continue this until your child's ADHD symptoms are controlled or they get side effects.

ADHD medication dosages should always be planned just for the needs of your child. There’s no blanket treatment plan that works for everyone with ADHD.

How Titration Works

The doctor will start your child on a low dose of medicine and then raise it little by little until your child gets the greatest benefit with the fewest side effects. They will need to be on each medication dose for about a week. That will give you and your doctor a good idea of whether it's working. If your child starts noticing side effects, it can help you figure out how bad they might be.

Some side effects get better over time. So it's important not to make changes too quickly, particularly if the medication works to control their symptoms.

When your child’s doctor makes the titration plan, they should take into account your child's height, weight, and symptoms. They should also ask about your child's daily schedule and your family's needs.

How Long Does ADHD Medication Titration Take?

It can take several weeks. Don’t be discouraged if the first medicine your child takes isn't the right fit. It’s not unusual for a doctor to have to titrate two or three types of medicine before finding the best match.

How Will You Know if Treatment Is Working?

Medication is an important part of the overall treatment plan for children with ADHD. Doctors often prescribe stimulant medications or other drugs to control ADHD symptoms like:

• Hyperactivity
• Impulsivity
• Inattention

When on a proper dose, you may begin to see some of these get better.

What About Side Effects?

They can depend on the medication your child is prescribed. Stimulant medications are the ones most often prescribed.

Common side effects of these can include:

• Less appetite
• Weight loss
• Trouble sleeping
• Stomachache
• Headache
• Dizziness
• Personality changes (not feeling as social or seeming sad, quiet, zombie-like, or irritable)

These often go away after a few weeks, so your doctor may encourage you to wait it out and see if they get better on their own.

Call your child’s doctor right away if you’re concerned or worried about side effects, especially if they’re getting worse. One example could be that your child develops tics. These can be small repetitive body motions like blinking or grimacing. Call instead of trying to take them off a medication yourself. If you stop medications suddenly, it can cause dangerous side effects.

Your child’s doctor can usually fix side effects. They can lower the dose, change the times they are taken, or even switch medicines.

What about rare side effects? Heart problems, liver problems, hallucinations (like seeing small bugs, hearing things, becoming suspicious, or having strange feelings on their skin), agitation, and suicidal thoughts can happen, rarely, with some ADHD medications.

If it’s an emergency, call 911. Other than that, contact your child’s doctor immediately. These things happen in less than 1 in 10,000 people, according to the American Academy of Child & Adolescent Psychiatry.

When Is the Best Time for Your Child to Start an ADHD Medication?

You may want to start during the weekend or over a school break so you can keep a close eye on your child for the first few days. You can also use this time to figure out the best time to take the medicine. For example, a younger child may need to take the medicine in the morning to focus throughout the school day, and a teen may need a stronger dose later in the afternoon to get through homework or to focus while driving home.

Titration and Your Role as a Parent

Prescribing ADHD medication isn't an exact science. It can sometimes take weeks or months to arrive at the right dose for your child. But during that time there are things to do.

Ask for information. Make sure that all your questions about the medication and the titration process are answered. And make sure that you fully understand what to expect from the medication before your child begins taking it.

Keep an eye on them. Parents, as well as your child, will need to participate in this process. ADHD medications affect every child differently. That's why it’s important to watch your child for improvements and side effects during titration.

Take notes. After your child has been taking the ADHD medicine for at least 1 week, you and your child's teachers should track ADHD symptoms. Your doctor may even give you special forms, called rating scales, to help with this. You and the teachers should be alert for and report any side effects that happen during treatment.

If there aren’t any problems after a month of treatment, see your child's doctor again. At that time, the doctor can make sure that:

• The medicine is working.
• The dosage is correct.
• The side effects are acceptable to you and your child.

Once the proper dosage is found, experts recommend visiting the doctor regularly -- about every 3 months. The doctor will check whether your child's medication plan is still right and works.

Types of Drugs for ADHD

The first drugs doctors commonly used to treat children with ADHD are stimulant medicines such as:

• Dexmethylphenidate (Focalin)
• Dextroamphetamine (Adderall)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Concerta, Quillivant, Ritalin)

It is thought that these medicines improve ADHD symptoms by making more of the chemical dopamine available to the brain. Dopamine is found in areas of the brain that control mood and attention.

Doctors may also consider prescribing a nonstimulant drug such as atomoxetine (Strattera), clonidine (Kapvay), guanfacine (Intuniv), and viloxazine (Qelbree). They mainly affect a different chemical, norepinephrine, which is also involved in attention, mood, and impulse control.

Other ADHD drugs include:

• Armodafinil (Nuvigil). A drug that promotes wakefulness and can improve attention, but carries a potential risk for serious skin rashes in children.
• Bupropion (Wellbutrin). An antidepressant that may help attention.
• Clonidine (Kapvay). A high blood pressure medicine that can improve attention.
• Guanfacine (Intuniv). A high blood pressure medicine that can improve attention.
• Venlafaxine (Effexor). An antidepressant that has been shown to improve attention in small studies.

Each of these drugs can have side effects. Some of these can take up to 6 weeks to start working.

Needs Can Change

What works at first may need to be adjusted over time. Watch your child for symptoms and side effects as they grow and their schedule and lifestyle change. Check in with the doctor every 3 months or so to make sure your child is still on the right treatment.

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