Vyvanse is an amazing ADHD medication for adults but it has a few problems when used for ADHD in children. This relatively new ADHD drug provides continuous stimulant coverage in a very smooth fashion. The drug consists of dextroamphetamine bonded to the amino acid lysine. The dextroamphetamine is only absorbed when the lysine bond is broken and this can only happen in the stomach or small intestine. This provides for an amazingly smooth delivery of the dextroamphetamine into the blood stream. This delivery system has the added effect of making this ADHD drug impossible to abuse as you will get no effect if you crush it, inject it or snort it.
Vyvanse’s effect is very long acting, between 12-14 hours and there are some physicians who believe that the stimulant effect of Vyvanse is stronger than the stimulant effect of other dextroamphetamines such as Adderall.
Many young children do extremely well on this ADHD medication except for two problems that are both related to the duration of action. The first problem is that these young children with ADHD are often not very hungry for the better part of 14 hours, which is the amount of time that the drug action usually lasts. At dinner time, the ADHD child may only eat a small amount of dinner. Families that have children with ADHD make all kinds of adjustments to family schedules and routines to accommodate problems such as this one. One family, I know, sets aside the ADHD child’s dinner plate until it is time for his bedtime snack. By that time he is hungry and he then eats the rest of his dinner.
The second problem is that children with ADHD have days when they do not need to have a stimulant on board for 14 hours. When a child with ADHD ‘sleeps in’ and wakes up at 11am it is likely that this child will still go to sleep at his regular bedtime 8-10 hours later. If this child is given Vyvanse however, he will be awake until 1 in the morning. There is no way to shorten the duration of action of Vyvanse. Giving him half the dose just halves the stimulant effect, not the duration of action.
I once heard a psychiatrist suggest to a parent of an ADHD child with this problem that she set her alarm for 7am on weekends and wake her child up and to give him his Vyvanse. A ridiculous suggestion such as this one is why physicians get the terrible reputation that they sometimes get. The Parents of Children with ADHD, who do not feel comfortable ‘talking back to a physician’, might have not have the nerve to tell their physicians what a thoroughly bad idea this is. I know of no parent, in their right mind, who is going to wake their peacefully sleeping ADHD child, at 7 am, on a stress less weekend morning to give them their stimulant medication.
A better suggestion from this psychiatrist would have been to offer this parent a medication with an 8-10 hour duration of action that could be used on days when the child slept late. My guess is that there are many parents of young children with ADHD who are struggling with what to do on days when a medicine with a 14 hour duration is impractical. Maybe a solution would be for the drug manufacturer to come out with a children’s monthly dose pack of Vyvanse that included two to four days of a shorter acting dextroamphetamine. These shorter acting pills would be used for the occasional days in the month when the child did not need 12-14 hour coverage.
Psychiatrist and physician’s treating children with ADHD and ADD who are taking Vyvanse should be routinely asking parents what they are doing,as far as medicating their children, on days when the children with ADHD sleep in late. Children with ADHD and children with ADD should not be off all medication simply because they woke up late and parents should not have to wake up taheir peacefully slumbering children to give them ADHD medication.
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