Cite this article as:
Mary Hardimon. Atomoxetine, Don't Forget the Bubbles, 2020. Available at:

James is a 7-year-old boy who was diagnosed with ADHD 2 years ago and was started on short-acting Ritalin 10mg in the morning and 10mg at lunch. Since you saw him 6 months ago, you notice that he has lost 3kg. This is in addition to the 2kg he lost when first starting stimulant medication. His mother has been supplementing his diet with high energy foods such as avocado, butter and nut but she is concerned about his weight loss despite these efforts and would like to discuss other medication options (as he has had a good effect reported by school with treatment). You have heard great things about atomoxetine (Strattera) but aren’t comfortable using it yet…


How does it work?

Strattera is thought to be a selective noradrenaline reuptake inhibitor (SNRI).


Indications for usage

Atomoxetine is indicated for ADHD (diagnosed according to DSM-V criteria) with any of the following:

  • Contraindication to dexamfetamine, methylphenidate or lisdexamfetamine as specified in TGA-approved product information
  • Co-morbid mood disorder that has developed or worsened as a result of dexamfetamine, methylphenidate or lisdexamfetamine treatment and is of a severity necessitating treatment withdrawal
  • Unacceptable medical risk of a severity necessitating permanent stimulant treatment withdrawal if given a stimulant treatment with another agent
  • Experienced adverse reactions of a severity necessitating permanent treatment withdrawal following treatment with dexamfetamine, methylphenidate, and lisdexamfetamine (not simultaneously)


TGA contraindications

  • Symptomatic cardiovascular disease – moderate/severe hypertension, atrial fibrillation/flutter, ventricular tachycardia, ventricular fibrillation, advanced atherosclerosis
  • Severe cardiovascular disorders – those whose condition would be expected to deteriorate if they experienced increases in blood pressure or in heart rate (for example, 15 to 20 mmHg in blood pressure or 20 beats per minute in heart rate)
  • Uncontrolled hyperthyroidism
  • Phaeochromocytoma – active or history of
  • MAO inhibitors
  • Narrow-angle glaucoma


Dosage and Administration

Initiated at 0.5mg/kg and increased after a minimum of 3 days to a target total daily dose of approximately 1.2mg/kg (may be given as a single daily dose or as evenly divided doses twice daily)


Adverse effects

Most common (>10%):

  • Headache
  • Insomnia or drowsiness
  • Hyperhidrosis
  • Xerostomia
  • Nausea/vomiting
  • Anorexia
  • Abdominal pain
  • Constipation


WARNING – There is an increased risk of suicidal ideation in children and adolescents


Attention Deficit Hyperactivity Disorder: David Coghill at DFTB18

Cite this article as:
Team DFTB. Attention Deficit Hyperactivity Disorder: David Coghill at DFTB18, Don't Forget the Bubbles, 2018. Available at:

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story’ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families. Tickets for DFT19, which will be held in London, UK, are now on sale from

The fidget spinner craze – the good, the bad and the ugly

Cite this article as:
Mary Hardimon. The fidget spinner craze – the good, the bad and the ugly, Don't Forget the Bubbles, 2017. Available at:

Unless you have been walking around with your eyes closed, you will have noticed fidget spinners are everywhere! If not in the hands of your little patients, then in the hands of their parents. But is the hype worth it? Whilst they are being marketed as the latest tool for helping those with ADHD and autism, many are left wondering will this actually improve learning or is it just another distraction in our already hectic lives?


Firstly, one must remember that a fidget spinner is a type of fidget toy. The terms are not in fact synonymous. Rather they are just one spoke for the umbrella term:

Fidget toys/tools aren’t new. Occupational therapists have been recommending them for years. Whilst evidence behind fidget toys as a group is sparse, generally just being anecdotal, studies have shown that sensory tools such as weighted blankets and vests can produce a calming and relaxing effect in children with ADHD and Autism. When in the “right hands,” these tools can improve concentration and learning whilst reducing anxiety.


We all have a sensory “profile”. Some people prefer deep pressure touch, whereas others cannot stand touch. Some people need music to study whereas others require silence. Some people like to move and touch everything in sight, whereas for others this is incredibly frustrating. The problem is that fidget spinners have oversimplified this. It suggests that every person’s sensory profile can be managed using what is predominantly a visual sensory tool. This is obviously not the case. If the young person requires proprioceptive stimulation to stay focused (think about that person that always shakes their legs whilst they work), a spinning toy is obviously not going to fill that need. Fidget toys – whilst undeniably useful when used appropriately – need to be targeted to the young person’s needs. Strict recommendations around fidget toys are also important to highlight their role as a tool rather than a toy. Teachers should be given recommendations surrounding utilization of these tools, as well as advice that should it not be used for its intended function (e.g. should the young person throw their stress ball rather than squeeze it) it should be removed for a short period.


Finally the ugly of the fidget spinner; when used inappropriately, not only are these toys distracting to other students (as well as their teachers and parents) but they can result in injury. Whilst choking and swallowed foreign bodies are a major concern, minor head injuries and incarcerated digits have been recorded.




Fidget tools are useful when applied to the right person with the right sensory profile.