Titration: what it is and how it works

Summary: Titration is how we find the right ADHD medication and dose for your child – usually over about 16 weeks. Our team will check in regularly, adjust their treatment, and help find a medication that's safe, stable and effective. 

• What is titration?

• How titration works

• How to access medication longer term

• FAQs 

This article applies if your child's been diagnosed with ADHD, or ADHD together with another condition like autism, where treatment often looks different. 

Everyone’s body responds to medication differently. Titration is how we find the right ADHD medication – and the best dose of it – for your child. 

Titration usually takes about 16 weeks. Throughout, your child's clinician will keep a close eye on how they're getting on, and adjust their medication along the way. The goal is to find the dose that helps the most, with as few side effects as possible. 

• Before your child starts medication, their clinician will look over their medical history to make sure it's safe to begin treatment. If anything else is needed – like a heart scan (ECG) or blood pressure readings – we'll let you know as soon as we can.

• When everything's in place, we'll ask you to fill out some forms in our patient portal on your child's behalf. Once those are done, we'll book all their titration appointments in one go – so you'll know exactly what's coming when. 

• At your child’s first appointment, you'll discuss the medications available, treatment goals, and what to expect. The appointment will be 45 minutes and take place over Microsoft Teams.

• Your child will start on a low dose to give their body time to adjust. You'll both get clear guidance on how and when your child should take their medication. ADHD prescriptions are issued one month at a time. 

• Taking medication every day 
  While your child is titrating, we ask that they take their medication every day – this helps their clinician build a clear, consistent picture of how it's working. Once they're on a stable dose, we can talk about whether medication breaks make sense for them.

• Meeting your child’s clinician 
  Over the next few weeks, you and your child will discuss how things are going with their clinician. From there, titration appointments are every four weeks and take place by video call on Microsoft Teams. It’s important that the child attends these appointments with their guardian so that they can describe their experiences directly to their clinician and have any questions answered. 

  The clinician will probably adjust the medication based on your child's symptoms. The goal is to find their "optimal dose" – the amount that relieves symptoms while keeping side effects to a minimum. 

• Recording your child’s symptoms 
  We encourage you (or your child, if they're old enough) to keep a symptoms diary, based on the target symptoms you agree with the clinician at your first titration appointment. This helps track how things are going, and gives your clinician a clear picture to work from at each review. In the diary, it helps to note:

  • A score out of 10 for each target symptom, where 1 means no difference and 10 means it's completely resolved

  • What your child likes and doesn't like about the medication, including any side effects

  • How long the medication takes to kick in, when it wears off, and how your child gets on

  • Their blood pressure, weight, pulse and any differences to do with their appetite or sleep

  • If you can, it's also worth checking in with their school – teachers often notice changes in focus or behaviour during the day that are useful. 

• Blood pressure and pulse monitoring 
  If your child is under 10 or of a small build, they may need a child-sized blood pressure cuff, as an adult one will usually be too big. The cuff should cover around three-quarters of the length of their upper arm. It's best to take readings from the same arm each time. 

• Raising questions or concerns 
  We want you and your child to feel in control of treatment, so please don't hesitate to ask questions or raise concerns during appointments. If a medication or dose isn't right for your child, your clinician will work with you to find a better solution.  

If your child needs any reasonable adjustments during titration appointments – like more time, a different way of communicating, or shorter appointments – please let us know at appointmentscyp@careadhd.co.uk and we'll do what we can to help. 

Once your child has completed titration and been on a stable dose for over eight weeks, you'll need to decide how they'll access medication going forward. There are two options: Shared Care with their GP, or a private prescription through us. 

• Shared Care: If your child’s GP agrees to Shared Care and your child is in full-time education, their prescription is free. If not, you'll pay the NHS prescription rate (currently £9.90 per item, or free if you're eligible).

• Private: If you'd prefer to continue with us privately, we charge £20 per prescription. The cost of the medication is paid directly to the pharmacy. Most people pay between £80–£160 per month. See more information on our ‘Managing ADHD medication and prescriptions’ page. 

How long does titration take? 

It usually takes 16 weeks, though it can take a bit longer if more adjustments to your child’s medication are needed, or if they have other needs impacting their health and wellbeing. 

Can you prescribe if my child has other health conditions? 
Yes, in most cases – but their clinician will always review their full medical history first, and may ask for extra checks, like an ECG or blood pressure readings, to make sure it's safe to start or continue treatment. 

How does the titration process differ for private and NHS Right to Choose patients? 

The process is the same, but private patients have a clinical review of their medical history and three titration appointments. NHS Right to Choose patients have an extra appointment. They also have access to up to nine appointments in total. Annual reviews are also free for NHS Right to Choose patients.  

What happens if my child's medication isn't stable after 16 weeks? 
 
You're welcome to book additional appointments with us. Private patients can purchase these as needed. NHS Right to Choose patients have access to up to nine appointments during titration, but more can be made available if needed.