Dexamphetamine vs Methylphenidate for ADHD in Children: What a 12-Month Study Reveals

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions diagnosed during childhood. For many children, ADHD symptoms such as difficulty concentrating, impulsivity, and hyperactivity can affect learning, relationships, and everyday activities. Treatment often involves a combination of behavioural support, educational strategies, family guidance, and, when appropriate, medication.

Two stimulant medications frequently used in ADHD treatment are methylphenidate and dexamphetamine. Both medicines have been shown to reduce ADHD symptoms, but doctors and families often want to know whether one works better than the other and whether their side effects differ.

A recent randomised study compared these two stimulant medications over 12 months to examine symptom improvement, treatment continuation, and changes in weight among children with ADHD.

Understanding Methylphenidate and Dexamphetamine

Stimulant medications are among the most widely studied treatments for childhood ADHD. They work by influencing brain chemicals involved in attention, focus, and impulse control.

Methylphenidate is commonly prescribed as an initial ADHD medication in many countries because of its established effectiveness and safety record.

Dexamphetamine, an amphetamine-based stimulant, is also effective for managing ADHD symptoms and may be prescribed when clinically suitable.

Although both medicines are considered effective, children can respond differently. Some may experience better symptom control with one medication, while others may experience fewer side effects with another.

About the 12-Month ADHD Medication Study

The study involved 100 children and adolescents aged between approximately 4 and 16 years who had not previously taken stimulant medication. Researchers randomly assigned participants to receive either immediate-release dexamphetamine or methylphenidate.

The research was conducted in specialist paediatric clinics in New South Wales, Australia, between 2016 and 2020.

The researchers monitored:

• ADHD symptom improvement
• Treatment continuation after 12 months
• Reasons for changing medication
• Side effects
• Weight and height changes

Medication doses were gradually adjusted during the first four weeks based on response and tolerance. Teachers also provided symptom ratings during this period to help measure changes in behaviour and attention.

Both Medications Improved ADHD Symptoms

The study found that both dexamphetamine and methylphenidate significantly improved ADHD symptoms.

Children taking either medication showed reductions in:

• Inattention
• Hyperactivity
• Impulsive behaviour
• Oppositional behaviours

When researchers compared the two groups directly, they did not find a significant difference in symptom improvement.

This suggests that, when carefully adjusted for each child, both medications can provide meaningful benefits for managing ADHD symptoms.

The results support the understanding that stimulant response is individual. A medication that works well for one child may not provide the same results for another, which is why monitoring and adjustment are important parts of ADHD treatment.

Medication Use After 12 Months

One important question researchers examined was whether children continued taking the medication they were initially assigned.

After one year:

• 68% of children originally assigned to methylphenidate remained on that medication
• 56% of children originally assigned to dexamphetamine remained on that medication

Although more children stayed with methylphenidate, the difference was not considered statistically significant.

This indicates that both medications had similar long-term acceptance within this study group.

Some children changed medication because of side effects, reduced benefit, or personal treatment preferences. The most common reasons for switching included:

• Reduced appetite
• Weight concerns
• Sleep difficulties
• Emotional or behavioural changes

Weight Changes: A Key Difference Between Treatments

The most notable difference between the two medications involved weight changes.

Both groups experienced some weight reduction after starting stimulant treatment, which is a recognised possible effect of ADHD medication.

However, children taking dexamphetamine showed greater weight loss, particularly during the first three months.

At three months:

• Dexamphetamine group: average weight loss of about 1.44 kg
• Methylphenidate group: average weight loss of about 0.31 kg

After 12 months, differences in weight patterns remained. Children taking methylphenidate showed some weight recovery, while the dexamphetamine group continued to show a small average reduction compared with baseline.

The researchers suggested that this finding may be important when selecting medication, especially for children where appetite or weight gain is already a concern.

What This Means for Families

The findings do not suggest that one medication is universally better than the other. Instead, they highlight that both methylphenidate and dexamphetamine can be effective options for children with ADHD.

The choice of medication may depend on several factors, including:

• A child’s symptom pattern
• Previous treatment response
• Side effect risks
• Appetite and growth concerns
• Family preferences
• Clinical recommendations

Regular monitoring of weight, height, appetite, sleep, and overall wellbeing remains an important part of stimulant treatment.

Limitations of the Research

While this study provides useful information, there are some limitations.

The research involved a relatively small number of participants and was conducted within specialist clinics under the care of one clinician. Because the study was open-label, families and clinicians knew which medication children were receiving, which may influence reporting of benefits or side effects.

The study also focused on a 12-month period. Longer-term research is needed to better understand growth patterns and outcomes over several years.

Conclusion

This 12-month randomised comparison found that dexamphetamine and methylphenidate produced similar improvements in ADHD symptoms among children.

Both medications were generally continued by many participants, suggesting that they can be effective long-term treatment options when appropriately monitored.

The main difference identified was weight impact, with dexamphetamine linked to greater weight loss compared with methylphenidate.

For families considering ADHD treatment options, these findings reinforce the importance of personalised care. Medication decisions should always be made with a qualified healthcare professional who can consider the child’s individual needs, benefits, and possible risks.

Source

Poulton A, Ng S, Do HC, Chau V, Simons J, Nilsson I, Zhang Y, Ng S, Dyson R, Bhurawala H. “A Randomised Open-Label Comparison of Dexamphetamine and Methylphenidate in Children With Attention Deficit Hyperactivity Disorder (ADHD): Symptom Response, Adherence and Weight Impact Over 12 Months.”
Journal of Paediatrics and Child Health. First published 7 July 2026. DOI: 10.1111/jpc.70487.

Disclaimer

This article is for educational and informational purposes only. It does not provide medical advice, diagnosis, or treatment recommendations. ADHD medications should only be started, changed, or stopped under the guidance of a qualified healthcare professional. Individual responses to medication can vary, and treatment decisions should always be based on a child’s specific health needs and circumstances.