ADHD in Children and Young People
A 9-year-old boy who was started on short-acting methylphenidate (Ritalin immediate release) 3 months ago (taken at 8:30am and 11:45am) presents for review. His ADHD symptoms have improved significantly. However, his weight is static and his BMI has dropped from the 25th to the 12th percentile. Appetite is reduced during school hours.
What is the most appropriate initial management?
- Stop medication immediately
B. Switch to atomoxetine
C. Add guanfacine (Intuniv)
D. Advise to encourage regular meals, incorporating high-calorie eating, and continue monitoring
E. Increase the stimulant dose
Correct answer: D. Advise high-calorie eating and regular meals, and continue monitoring.
Explanation: Appetite suppression is common with stimulant medications such as methylphenidate. Management strategies include increasing energy intake via high calorie foods of good nutritional value, meal timing (additional meals or snacks early in the morning or later in the evening when stimulant effects have worn off; changing timing of medication to with/after food rather than before meals), obtaining dietary advice, dose adjustment (reducing dose or changing/stopping medication), and considering stimulant free days on weekends and during school holidays to allow ‘catch‑up’ growth if clinically appropriate. Non-medication causes of weight loss should also be considered.
See 5.7.6 in the Australian Evidence-Based Clinical Guideline for ADHD: Summary of Recommendations: https://adhdguideline.aadpa.com.au/about/recommendations-summary/#recommendations
An 11-year-old girl has been stable on long-acting methylphenidate (Ritalin LA) for 18 months under shared care with her paediatrician. You are reviewing her in your GP clinic.
How often should height be monitored in children on stimulant medication?
- A. Weekly
- B. Monthly
- C. Every 3–6 months
- D. Annually only
- E. Only if parents are concerned
Correct Answer: C. Every 3–6 months
Explanation: Growth (height and weight) should be monitored at least every 6 months in children and young people on stimulant medications. Plotting on growth charts is recommended to detect growth suppression early.
See 5.7.6 in the Australian Evidence-Based Clinical Guideline for ADHD: Summary of Recommendations: https://adhdguideline.aadpa.com.au/about/recommendations-summary/#recommendations
A 12-year-old boy on lisdexamfetamine (Vyvanse) attends your GP clinic for medication monitoring. His blood pressure is now consistently above the 95th percentile for age and height on three separate readings.
What is the most appropriate action?
- A. Continue medication unchanged
- B. Increase stimulant dose
- C. Stop medication immediately without discussion
- D. Discuss with specialist about dose reduction or treatment review
- E. Start antihypertensive therapy in primary care
Correct Answer: D. Discuss with specialist about dose reduction or treatment review
Explanation: Stimulants such as lisdexamfetamine (Vyvanse) may increase BP and pulse. Persistent hypertension (BP >/= 95th percentile for age, gender and height) requires liaison with the initiating specialist. Dose reduction, medication change, or further management/investigation may be required.
In paediatrics it is important that the correct cuff size is used and BP should be confirmed with a manual syphgmomanometer (as some automatic machines can create a stressful experience for children).
See 5.1.4 in the Australian Evidence-Based Clinical Guideline for ADHD: Summary of Recommendations:
Further info can be found on the RCH Guidelines on Hypertension:
- Ensure the correct cuff size is selected for each child/young person, favouring a larger rather than smaller cuff (smaller cuff creates artificial hypertension)
- BP cuff width should be 40% of the length of the arm measure from the shoulder tip to the elbow
- Abnormal oscillatory BP measurement needs checking with a manual BP from the child’s arm
Normal BP ranges for gender, age and height can be found on UpToDate using the search term “normal BP children”.
A 7-year-old girl is being started on stimulant medication by a community paediatrician. You will be involved in ongoing shared care.
Which of the following should be documented at baseline before starting treatment?
A. Serum prolactin
B. Height, weight, blood pressure, and pulse
C. Routine ECG for all children
D. Liver function tests
E. Fasting glucose
Correct Answer: B. Height, weight, blood pressure, and pulse
Explanation: Before starting stimulants such as methylphenidate or lisdexamfetamine, baseline height, weight, BP, pulse, and cardiovascular history (including family history of sudden death) should be recorded. Routine ECG is not required unless indicated by history. Medical investigations should only be performed if clinically indicated, for instance screening for nutritional deficiencies based on a restricted diet/low dietary iron intake.
For more details, see 5.1.2 and 5.1.3 in the Australian Evidence-Based Clinical Guideline for ADHD: Summary of Recommendations: https://adhdguideline.aadpa.com.au/about/recommendations-summary/#recommendations
Webinar Recording: Supporting & Managing patients with ADHD – a paediatric perspective Wednesday 11 March 2026
Learning Outcomes:
- Describe ADHD reforms in NSW including pathways for GPs to become prescribers
- Effectively monitor children and young people with ADHD
- Identify treatment management options in paediatric and young person ADHD for children and young people including medications
- Increase knowledge in ADHD presentations and care, with particular focus on considerations relevant to children and young people
Speakers:
- Dr Tamasin Meller | Community Paediatrician, Dalwood/Northern Beaches Community Paediatric Clinic, NSLHD
- Dr Lisa Collins | General Practitioner (BMBS FRACGP MRCGP DCH DRCOG PgDipDerm) | GP Education Lead for First 2000 Days, SNHN
- Dr Anna Gill | Staff Specialist Paediatrician Hornsby Ku-ring-gai Hospital | Clinical Network Director Children and Young People NSLHD
ADHD Endorsed training courses – applications are open to obtain a General Authority as a continuation prescriber. Before submitting your application to the NSW Ministry of Health training must be completed. For further information on training options and application process please click here.