234 The Explosive ChildINATTENTION AND DISTRACTIBILITYIf inattention and distractibility are significantly interfer-
ing with your child’s academic progress or with his abil-
ity to participate in Plan B discussions, medication may
offer some promise. The mainstays of medical treatment
for inattention and cognitive inefficiency are the stimulant
medications, some of which have been in use for more
than sixty years. This category of medicines include well
known, well studied agents such as methylphenidate (Ri-
talin) and dextroamphetamine sulfate (Dexedrine). Stim-
ulants come in short- and long-acting preparations. In
most cases, the side effects associated with stimulants
tend to be mild, but they are worth mentioning. Two of
the more common side effects are insomnia (especially
if a full dose is administered after the mid- to late-
afternoon hours) and loss of appetite, which can, over
the long term, result in weight loss. In some children,
stimulants may unmask or exacerbate existing vocal or
motor tics (this circumstance may require adding a sec-
ond medication to reduce the tics or discontinuing the
stimulant medication). Stimulants may increase anxiety
and irritability in some children, an undesirable circum-
stance for any child but perhaps especially an explosive
one. The behavior of some children can deteriorate when
stimulant medication wears off (a phenomenon called
rebound), and this side effect is sometimes addressed by