# Ask about amphetamine alternatives

Published by Pawel Jozefiak. [About this project](https://adhd100.jock.pl/about/), [How we check sources](https://adhd100.jock.pl/methodology/)

- Canonical: https://adhd100.jock.pl/discuss-amphetamines-child/
- Language: en
- First published: 2026-09-29
- Evidence checked: 2026-09-29, using AI-assisted source verification
- Clinical review: Not clinically reviewed
- Number 6 of 100 in the list: https://adhd100.jock.pl/#discuss-amphetamines-child

When the first stimulant has not helped enough, an amphetamine medicine is an option for some children.

**The number:** Children and teens: large symptom improvement vs placebo over about 12 weeks (SMD 1.024) ([BMJ / Gosling et al., 2025](https://raw.githubusercontent.com/CorentinJGosling/EBI-ADHD-UR-2025/86eff22a9ffb/datasets/dataset-ur-adhd.csv))

## The evidence

- How sure: Certainty of evidence: Moderate certainty. Measured in people with ADHD.
- See this comparison on the evidence map: https://adhd100.jock.pl/evidence/#r-amphetamines-youth-core-adhd-symptoms-clinician-rated-short
- Evidence grade: A. Grade A: moderate or high certainty evidence in people with ADHD, or an explicit ADHD guideline recommendation.
- Basis: EBI re-estimation: 5 trials, 876 children and adolescents, short term; NICE NG87 1.7.8 second-line option
- Outcome: clinician-rated core ADHD symptom improvement in youth
- Comparison: vs placebo
- 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.

## 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

1. Give the clinician a summary of what previous treatment did, good and bad.
2. Ask whether the current treatment has been given a fair assessment before switching is discussed.
3. Talk about why a different stimulant might suit your child better, and what the new monitoring would involve.
4. Bring your child's own preferences and the school's feedback into the decision.

## Talk to a clinician first

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

### Start now

- 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.

### What it looks like

- 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.

### Common mistakes

- Effect sizes from separate trials cannot tell you which medicine is best for your child. Ask about how your child responds.
- One medicine not fitting does not close off the other options. Ask for a review.

### A structured start

**Review the need for an alternative**

1. Summarise the current treatment experience.
2. Ask the clinician whether a different stimulant is appropriate.
3. Agree how the chosen plan will be monitored.

### Trusted how-to guides

- [Common questions about methylphenidate for children](https://www.nhs.uk/medicines/methylphenidate-children/common-questions-about-methylphenidate-for-children/), NHS
- [Tips for Talking With a Health Care Provider About Your Mental Health](https://www.nimh.nih.gov/health/publications/tips-for-talking-with-your-health-care-provider), NIMH

## Sources

- [EBI-ADHD: companion data to Gosling et al., BMJ 2025, commit 86eff22a9ffb](https://raw.githubusercontent.com/CorentinJGosling/EBI-ADHD-UR-2025/86eff22a9ffb/datasets/dataset-ur-adhd.csv), BMJ / Gosling et al., 2025 (Tier 1 guideline)
- [Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making](https://pmc.ncbi.nlm.nih.gov/articles/PMC12651917/), BMJ, 2025 (Tier 1 guideline)
- [Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations](https://www.nice.org.uk/guidance/ng87/chapter/Recommendations), NICE, 2019 (Tier 1 guideline)
- [Common questions about methylphenidate for children](https://www.nhs.uk/medicines/methylphenidate-children/common-questions-about-methylphenidate-for-children/), NHS, 2025 (Tier 1 guideline)

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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.

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