Your Child Is Starting ADHD Medication

How ADHD Medication Works and What Titration Means

If your child has been diagnosed with ADHD, medication is one of the evidence-based treatments. The most commonly prescribed medication for children in the UK is methylphenidate, sold under brands like Ritalin, Equasym, and Medikinet. There are other medications like atomoxetine and guanfacine, but methylphenidate is the first-line choice.

Methylphenidate works by increasing dopamine and noradrenaline in the brain, which helps with focus, impulse control, and attention. It's not a sedative. It doesn't sedate ADHD children into compliance. Instead, it helps their brain function more typically so they can access their own ability to focus and self-regulate.

Titration is the process of finding the right dose for your individual child. Every child metabolises medication differently. A dose that works brilliantly for one child might be too much or too little for another. Titration involves starting at a low dose and gradually increasing it while monitoring how your child responds. This process typically takes weeks or months. Your child might start on 5mg and gradually increase by 5mg increments every week or two, depending on response and side effects, until you find the sweet spot where ADHD symptoms are well-managed and side effects are minimal or absent.

What Happens During the First Weeks

When your child starts medication, expect to see some changes fairly quickly, though it's not an instant transformation. Many parents report noticing differences within the first few days: their child is slightly more focused, a bit calmer, more able to follow instructions. By week two or three, changes are usually more obvious. But you'll be increasing the dose regularly, so the picture keeps shifting.

The first weeks can feel unpredictable. Your child might seem focused at one dose and then when you increase, there might be side effects or the benefit plateaus. You'll be asked to keep notes on how your child is doing at school and at home: are they less impulsive, better able to focus, calmer or more irritable? Are they eating and sleeping normally? Is there anything that concerns you?

This is the tricky bit. You need to communicate regularly with whoever's managing the medication, usually your paediatrician or the ADHD clinic. If you're working with a GP under shared care, you'll see the clinic first for titration, then GP takes over. But during titration, you're in regular contact with the specialist, often weekly or fortnightly, adjusting the dose based on your feedback.

During this time, your child's school needs to be part of the picture. Let the SENCO or class teacher know your child is being titrated on ADHD medication and ask them to observe behaviour and focus changes. School feedback is often more objective than parental observation because the baseline is consistent classroom demand.

Side Effects and Managing Them

Most children tolerate ADHD medication well, but side effects do happen and they're part of the process. The most common side effects in the early weeks are decreased appetite and mild sleep disruption. Some children become slightly more irritable or withdrawn. Occasionally you'll see tics emerge or worsen if a child has a predisposition.

Decreased appetite is the big one parents notice. Your child might eat less lunch or pick at dinner. This usually improves as the body adjusts, but if it persists, it matters. You can manage it by ensuring meals are nutritious and calorie-dense, offering snacks at times when medication has worn off (usually evenings), and monitoring growth. Most children's appetite normalises as they adjust to the dose.

Sleep disruption is also common early on. Some children take longer to fall asleep or wake earlier. Again, this often improves with adjustment or dose timing. If your child is taking long-acting medication once daily, taking it early in the morning helps avoid evening wakefulness. Some children do better on two shorter-acting doses.

If your child develops tics or you notice personality changes like becoming withdrawn or emotionally flat, flag this immediately with the prescriber. These aren't minor side effects and dose adjustment or medication change might be needed. The goal is to manage ADHD symptoms while keeping your child feeling like themselves.

Most side effects settle within a few weeks of reaching a stable dose. If they don't, the prescriber might adjust the dose slightly or try a different formulation. Finding the right fit takes patience but it's worth it.

Shared Care Agreements and GP Involvement

Once your child is stabilised on a dose, responsibility for monitoring usually passes from the specialist clinic to your GP through something called a shared care agreement. This is a formal arrangement that allows GPs to prescribe and monitor ADHD medication rather than leaving it entirely to the specialist clinic.

Shared care is meant to free up specialist capacity and make it easier for families because you're monitored locally by your GP. In theory it's a good system. In practice it's complicated because not all GPs agree to shared care. About 20% of GPs refuse to take part in ADHD shared care agreements, citing concerns about monitoring or lack of expertise. If your GP refuses, you're stuck seeing the specialist clinic indefinitely, which can mean waiting months between appointments and fighting for prescription refills.

If your GP refuses shared care, you have recourse. You can request a different GP at your practice, or you can appeal to your GP practice manager about why shared care is important for your child's care. You can also use the Right to Choose pathway (discussed below). The point is that refusal shouldn't be final. You have options.

Once shared care is in place, your GP monitors your child annually with growth measurements, blood pressure checks, and discussions about how the medication is working. You'll get repeat prescriptions through your GP, which is more convenient. The specialist clinic still sees your child periodically, but less frequently.

The Right to Choose Pathway

If you're unhappy with your local ADHD service or waiting times are unacceptable, you have a legal right to choose an alternative provider. This is called the Right to Choose, and it applies to ADHD diagnosis and management.

Under Right to Choose, you can ask your GP to refer you to a private ADHD diagnostic service instead of waiting for NHS CAMHS. You'll typically pay for the private diagnosis, but once diagnosed, you can ask your GP to take on shared care and you'll get prescriptions on the NHS. This is a way to bypass long waiting lists and get diagnosed and started on treatment faster.

Right to Choose is particularly useful if your local NHS service has waiting times of over a year. Many private ADHD services can see you within weeks. The cost varies but typically you're looking at several hundred pounds for assessment and then shared care prescriptions are free on the NHS.

Not all GPs are enthusiastic about taking on shared care for Right to Choose patients, which is frustrating, but legally they can't refuse entirely. If your GP is unhappy, escalate to the practice manager or change GP. The system is meant to work this way.

Right to Choose is worth considering if you're facing long waits and your child is struggling now. Yes, you pay for private assessment, but you're buying speed and you're still getting NHS-funded ongoing management through your GP.