Ask about amphetamine alternatives
When the first stimulant has not helped enough, an amphetamine medicine is an option for some children.
Moderate certaintyADHD evidence
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. See this row on the evidence map
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 The benefit score is an editorial prioritization for the general list, weighted by certainty. It is not a prediction of 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.