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ADD/ADHD Medications: Problems Remain with School Breakfasts

Posted Jul 01 2008 4:10pm

ADD/ADHD Medications Work - School Breakfast Timing Requires Careful Attention

I was up in New Haven recently and had several conversations with pediatriciansBreakfastadd

and child psychiatrists aboutschool breakfasts, - provided at school for many of the metro children as a service to ensure they had proper AM nutrition. It's sponsored bystate and federal and state governments, and is helpful for many.

We strongly support school breakfast plans, - except for this small but overlooked, very important detail:

The Breakfast at School Problem:frequently reported challenge with ADD medications with hundreds of metro children... and this happens everyday in cities all over the US:

All stimulantsoften createsignificant medications problems when given on an empty stomach- from Concerta, to Adderall, toVyvanse, and even the non-stimulant, less effective Strattera, should be given to childrenfollowing breakfast...

Let me say that again:Following Breakfast.

Breakfast is a big deal
with stimulant medications.

I confess that I haven't pulled out a magnifying glass to review the FDA approved package inserts [PIs] recently, but here's what happens to many children who take medications before breakfast: the old bugaboo - significant side effects - and here is why side effects occur:

It has much to do with a favorite topic of mine in previous posts:The Therapeutic Window

The timing for stimulant medications in many of these homes is soon before the kids go out the door. But sometimes they don't eat until 45 min later.

Here's what happens:

  • The incidence of not eating breakfast, then skipping lunch increases
  • Weight loss due to:
  • Gastric irritation
  • With repeated attempts with different medications theyappear untreatable!!
  • They can't takeany of the medications, because this problem is pervasive and includes all AM meds including antidepressants.
  • The therapeutic window is not as clear, and they appear to overreact to the stimulant medications
  • Atypical reactions to medications compromise school behaviors
  • Inability for the medical team to clearly see theduration of effectivenessof stimulant medications
  • Crash in the PM increases
  • Self esteem goes into the tank
  • Sleeping in class
  • Nutritional compromise with no energy to play, because they only nibble after the stimulant medications irritate the gastric mucosa
  • I love the new stimulant medicationVyvanse, and these problems happenlesswith Vyvanse, but is still a problem and needs to come into treatment considerations.
  • The medications are most frequentlynot the problem - the problem is the empty stomach.
  • Breakfast before the meds regularly solves this array of side effects.


  • Write the orderfor the stimulant medications to be givenat the school after breakfast! Make this pattern a routine!
  • Give the kidssomesolid food before they leave home,before they take the medications at home.

As I regularly have indicated elsewhere in CorePsychBlog... timing with psychiatric medications is a requirement.

Stay tuned: inResolving the 10 Biggest Problems with ADD Medications, the CorePsych teleseminar series early this fall, I will be covering topics like these in much more detail - live with Q&A.

Post any comments on this challenging problem, would love to hear your take!


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