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How Genetic Testing for ADHD Medication Can Personalize Treatment

genetic testing for adhd medication

If you’ve watched your child struggle for months to maintain focus or sit still, it can be a relief to hear a diagnosis of attention-deficit/hyperactivity disorder (ADHD). Now you understand why school or activities may be difficult for your child.

Plus, getting a proper diagnosis is an important step in helping your child get treatment and navigate everyday life.

But if your child’s clinician recommends ADHD medication, you may have a few more hurdles ahead (check out these tips to feel prepared). Though there are many medications that can help children with ADHD, it can be a challenge to find the appropriate one for your child.

“I’ve been a clinician for 30 years, and it’s well-established that not all kids respond to the most commonly prescribed medications for ADHD,” says Amy Edgar, APRN, a nurse practitioner and founder of the Children’s Integrated Center for Success in Allentown, Pennsylvania.

In some cases, the medication simply won’t work for your child. As an example, an estimated 30% of people with ADHD do not respond to stimulants.1 On the other hand, some children may experience side effects, such as loss of appetite, irritability, headaches, or trouble sleeping.2

What to do? One option: Some clinicians order genetic testing for ADHD medication, which can provide information about your child’s unique genetic makeup to help them personalize treatment. This type of testing falls under the category of pharmacogenetic testing.

Edgar, for example, uses pharmacogenetic testing from Genomind, which looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions, including ADHD, and 130+ medications to help her determine:

  • Which medications may be more likely to be effective
  • Which medications may be more likely to cause side effects
  • How the patient metabolizes medications for personalized dosing guidance

Edgar uses this information, along with her clinical evaluation and the wishes of the child and parents, to tailor treatments for each child. “That’s how we understand a child and are able to put together a high-value target for treatment,” Edgar says.

3 Ways Genetic Testing for ADHD Medication Can Help

Genetic testing, specifically pharmacogenetic testing, can help in a number of ways when it comes to ADHD management. This information can provide clinicians with a greater insight on the likelihood of response to medications, how to more precisely dose certain medications for each individual, and how to better help patients meet their goals for treatment.

Genetic Testing Can Help Clinicians Determine Which ADHD Medications to Try

ADHD medications fall into two main classes: stimulants and nonstimulants.3 Though they can both be used to treat ADHD, they work differently, and children may not react to them in the same way.

Stimulants

This class includes methylphenidate (for example, Ritalin or Concerta) and amphetamines (for example, Adderall or Vyvanse).

Stimulants, Edgar explains, give dopamine and norepinephrine to your brain. Dopamine and norepinephrine are neurotransmitters, meaning they transmit signals to different areas of the brain. Specifically, dopamine is tied to attention, motivation, and movement.4

“Stimulants are waking up part of the brain that’s asleep for the child,” Edgar says. “It turns on executive function powers. Now, attention regulation is not so challenging, and they’re less easily distracted.”

Nonstimulants

Nonstimulants, on the other hand, will target the neurotransmitter norepinephrine. Like dopamine, norepinephrine increases activity in the part of the brain that helps children stay on task, manage impulses, and solve problems.5 Examples of nonstimulant medications include atomoxetine (Strattera) and viloxazine (Qelbree).

“These medications are working differently than stimulants, but the impacts may be the same,” Edgar says. “They’re a nice alternative if a child isn’t a good candidate for a stimulant.”

Another subgroup of nonstimulants include the medications clonidine (Kapvay) and guanfacine (Intuniv). These medications can work well “when the target is hyperactivity,” Edgar says. That’s because they modulate norepinephrine and lessen the stimulation in the body’s central nervous system. The result can be a calming effect and an improvement in concentration.6

How the Genomind Test Can Help With ADHD Drug Selection

The traditional way of starting a child on ADHD medication can include cycles of trial and error. “You pick one medication, and you switch, switch, switch on one side of the class,” Edgar says. “If that doesn’t work, you go to the other side of the class.”

With the Genomind test, clinicians can see a child’s pharmacodynamic genes, which can provide insight into how a medication might work for that particular child.

“The COMT gene is one of my favorites,” Edgar says. “It has three different presentations—one being typical and the other two being atypical. One of the atypical presentations is associated with a higher likelihood of responding to stimulant medications.

For Edgar, the Genomind test helps her make more informed medication decisions the first time around. “We know that stimulants aren’t right for every child,” she says. “This test gives me a piece of information that tells me why, or possibly why, and helps me decide, based on the individual, where to start with medication.”

Genetic Testing for ADHD Medication Can Help Clinicians Determine How to Dose Medications

After a clinician picks an ADHD medication class—stimulant or nonstimulant—the next step is figuring out which medication within that class and at which dose.

This is where the Genomind test information on a child’s CYP450  genes can help, Edgar says. CYP450 genes, often called metabolism genes, are responsible for how your child’s body breaks down medication.

Poor or Intermediate Metabolizer

If your child’s body metabolizes a medication too slowly, medication levels may be higher in the body. This could increase their risk of side effects.

Rapid or Ultrarapid Metabolizer

If your child’s body metabolizes a medication too quickly, medication levels may be lower in the body and your child may be at risk of not getting a benefit from the prescribed dose. Depending on the medication, the dose may need to be increased to function as it’s intended (relieve symptoms) or an alternative treatment may be considered.

How the Genomind Test Can Help With ADHD Dose Decisions

Edgar provides an example. Some stimulants (amphetamines) may be impacted by CYP450 genes. “Let’s go look at the metabolism genes and make sure they’re metabolizing the medication typically,” she adds. “If they’re not—if they’re a poor, an intermediate, or an ultrarapid metabolizer—that can have an impact on dosing.”

Some kids, she explains, will need a lower dose. Others will need a higher dose or even a split dose to get the medication to be effective consistently throughout the day.

Additionally, Edgar uses information from pharmacogenetic testing to gain more information on medications patients are already taking. Sometimes new patients will come to her already on the highest possible doses of stimulants or on a combination of medications. These patients may also be experiencing a cluster of side effects that are counterproductive to treating their ADHD or a lack of effect from their medications.

“Under those conditions, I will start to decrease until we get to an acceptable quality of life for the child and the family,” Edgar says. “And then we can decide on a new course of treatment that may allow them to see better outcomes.”

Genetic Testing for ADHD Medications Can Help Families Get on the Right Track with Treatment

Children with ADHD may share similar symptoms, but each child is unique and will have individual treatment goals. For example, one child may need more help staying focused at school, but another child may be more concerned about handling social interactions.

The goal of ADHD treatment is to improve the quality of life for the child and the family. The Genomind test can help in the evaluation of different medications against the primary symptoms that the child and family have defined as their main target, Edgar says.

“Using precision medicine allows us to improve the quality of the family’s experience,” Edgar says. By taking into account a child’s genes along with their medical history, lifestyle, and other factors, Edgar can make more personalized decisions about ADHD medication management.

With this strategy, Edgar says her clinic is able to see positive results in an average of three visits. For her, that means the child and family are seeing fewer symptoms with minimal side effects.

“Everyone feels like this is a good thing,” Edgar says. “That’s how we evaluate success with medication trials.”

Does Your Medication Work for You?

Get a lifetime of mental health treatment guidance. Genetic testing for ADHD medication is designed to help a clinician personalize your child’s treatment plan based on their genetic profile. Get started today.

 

Sources

  1. 30% patients do not respond to stimulants: Non-Stimulant Treatment for Attention Deficit Hyperactivity Disorder (2005)
  2. Common side effects of ADHD meds in children: Potential side effects of ADHD medicine (2020)
  3. Two classes of ADHD Medication: ADHD Quick Facts: Medication in ADHD Treatment (2020)
  4. Effects of dopamine: How Does Dopamine Affect the Body? (2019)
  5. Effects of norepinephrine on ADHD brain: ADHD Neuroscience 101 (2022)
  6. How Clonidine relieves certain ADHD symptoms: Clonidine as a Medication Choice for ADHD (2021)

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