Ask about amphetamine alternatives
Moderate certaintyADHD evidence
An option for some children when the first stimulant hasn't helped enough.
Start with the time you have
1 minute
Write down one thing that went well and one that didn't on your child's previous treatment.
5 minutes
Write what helped, what did not, and what your child found uncomfortable.
15 minutes
Pull together a summary of previous treatment to go through with the prescriber.
A plan
Review the need for an alternative
- Summarise the current treatment experience.
- Ask the clinician whether a different stimulant is appropriate.
- Agree how the chosen plan will be monitored.
How sure the science is
Moderate certainty, ADHD evidence
- The number is probably close, but more research could move it.
- Measured in people with ADHD.
- 5 trials
- 876 people
- children and teens
- clinician rated
- about 12 weeks
- measured on core ADHD symptoms
EBI re-estimation: 5 trials, 876 children and adolescents, short term; NICE NG87 1.7.8 second-line option.
The number, drawn
Why it matters
- Amphetamine medicines act on brain signalling involved in attention and impulse control.
- In children and adolescents, EBI found a large improvement in clinician-rated symptoms, 1.024 SMD versus placebo, with moderate certainty, over about 12 weeks or to trial endpoint.
- That does not make amphetamines the best choice for every child.
- NICE suggests considering lisdexamfetamine after a 6-week methylphenidate trial that did not help enough, and more children than on placebo stopped because of adverse effects, so tolerability belongs in the conversation.
How to do it
- Give the clinician a summary of what previous treatment did, good and bad.
- Ask whether the current treatment has been given a fair assessment before switching is discussed.
- Talk about why a different stimulant might suit your child better, and what the new monitoring would involve.
- Bring your child's own preferences and the school's feedback into the decision.
- These are clinician-led alternatives, not interchangeable medicines.
- Appetite, sleep and cardiovascular effects need review; the youth estimate does not describe adult efficacy.
Putting it into practice
In real life
- A few lines on what got better and what stayed hard on the earlier treatment.
- Ask whether the problem now is how long the benefit lasts, or the side effects.
Watch out for
- Common mistakeEffect sizes from separate trials cannot tell you which medicine is best for your child. Ask about how your child responds.
- Common mistakeOne medicine not fitting does not close off the other options. Ask for a review.
Trusted guides
How we rated it
- Evidence grade
- A Moderate or high certainty evidence in people with ADHD, or an explicit ADHD guideline recommendation.
- The number
- Children and teens: large symptom improvement vs placebo over about 12 weeks (SMD 1.024) (BMJ / Gosling et al., 2025)
- Benefit
- 84/100 An editorial priority for the general list, weighted by certainty. It does not predict what will happen for you.
- Effort
- Some effort
Sources
- Tier 1 guidelineEBI-ADHD: companion data to Gosling et al., BMJ 2025, commit 86eff22a9ffbBMJ / Gosling et al., 2025
- Tier 1 guidelineBenefits and harms of ADHD interventions: umbrella review and platform for shared decision makingBMJ, 2025
- Tier 1 guidelineAttention deficit hyperactivity disorder: diagnosis and management (NG87), recommendationsNICE, 2019
- Tier 1 guidelineCommon questions about methylphenidate for childrenNHS, 2025
- General information about ADHD, not a diagnosis or an individual treatment plan.
- Tailoring changes the order of suggestions; it does not assess you.
- Medication decisions belong with you and a qualified clinician.