Medication will not be needed for all individuals with ADHD and should only be used when the symptoms are pervasive across settings and are causing significant impairment in academic, social, or behavioral domains. Individuals receiving medication require regular review, at least six monthly. Medications for ADHD include stimulant (methylphenidate and dexamphetamine) and nonstimulant medications (eg, atomoxetine). Stimulant medications are thought to act by altering the availability of dopamine and noradrenaline, which influences behavior inhibition, impulse control, and attention.3 Clinicians should consider trialing dexamphetamine first, because there is some evidence suggesting that children with FASD have a preferential response to dexamphetamine over methylphenidate. Methylphenidate is available in immediate-release and extended-release formulations, but there is no evidence regarding the use of extended-release methylphenidate preparations in children with FASD. Atomoxetine is a nonstimulant medication which is classified as a noradrenaline reuptake inhibitor.3 The evidence regarding atomoxetine use in FASD is pending. There is no evidence available regarding the use of other nonstimulant medications in FASD.
