Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents

J Child Psychol Psychiatry. 2013 Mar;54(3):227-46. doi: 10.1111/jcpp.12036. Epub 2013 Jan 7.


Background: Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence- and expert-based guidance concerning the management of (AEs) with medications for ADHD.

Methods: For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta-analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence-level of the management recommendations was based on the SIGN grading system.

Results: The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms.

Conclusion: Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Atomoxetine Hydrochloride
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Blood Pressure / drug effects
  • Body Size / drug effects
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / prevention & control
  • Central Nervous System Stimulants / adverse effects*
  • Child
  • Clonidine / adverse effects
  • Dextroamphetamine / adverse effects
  • Growth Disorders / chemically induced
  • Guanfacine / adverse effects
  • Heart Rate / drug effects
  • Humans
  • Lisdexamfetamine Dimesylate
  • Methylphenidate / administration & dosage
  • Methylphenidate / adverse effects
  • Propylamines / administration & dosage
  • Propylamines / adverse effects
  • Psychoses, Substance-Induced
  • Seizures / chemically induced
  • Seizures / therapy
  • Sleep Wake Disorders / chemically induced
  • Sleep Wake Disorders / therapy
  • Substance-Related Disorders / etiology
  • Substance-Related Disorders / therapy
  • Suicide Prevention
  • Tic Disorders / chemically induced
  • Tic Disorders / therapy
  • Treatment Outcome


  • Central Nervous System Stimulants
  • Propylamines
  • Methylphenidate
  • Guanfacine
  • Atomoxetine Hydrochloride
  • Clonidine
  • Lisdexamfetamine Dimesylate
  • Dextroamphetamine