Attention Deficit Hyperactivity Disorder (ADHD)
Treatment Overview
Initial treatment
Successful treatment of attention deficit hyperactivity disorder (ADHD) begins with an accurate diagnosis and understanding of a child's weaknesses and strengths. Learning about ADHD will help you and your child's siblings better understand how to help your child.
The American Academy of Pediatrics (AAP) guidelines recommend medicine and/or behavior therapy to treat children with ADHD. This recommendation is based on numerous studies, including the landmark Multimodal Treatment Study of Children with ADHD (MTA), funded by the U.S. National Institute of Mental Health (NIMH). In this large study, researchers found that school-age children with ADHD who received stimulant medicine had a significant decrease in core ADHD symptoms (inattention, impulsivity, and hyperactivity).6
Your child's doctor may recommend that your child take a stimulant medicine, such as amphetamine (for example, Dexedrine, Adderall) or methylphenidate (for example, Ritalin, Concerta, Metadate CD). These medicines improve symptoms in about 70% of children who have the condition.7
Although it may seem contradictory, stimulants usually decrease hyperactivity and impulsivity and improve focus. Some parents worry about their children becoming addicted to stimulants. Research has shown that these medicines, when taken correctly, do not cause dependence. But parents should closely supervise the use of ADHD medicines, because abuse by siblings, classmates, and adults has been reported.
Parents are also often concerned about medication side effects, including loss of appetite, nervousness, tics or twitches, and problems sleeping. Children should be closely monitored after they start medicines, to assess whether they are receiving the correct dose. These side effects usually decrease after a few weeks on the medicines, or the dosage can be lowered to offset side effects. For more information, see:
Atomoxetine (Strattera) is a nonstimulant medicine that may be prescribed if stimulant medicines are not effective or have bothersome side effects. Strattera is not a controlled drug, which means refills on prescriptions and telephone prescriptions are allowed.
The AAP guidelines also encourage behavior therapy. Through behavior therapy, parents learn strategies, such as positive reinforcement, to improve a child's behaviors. Children learn to develop problem solving, communication, and self-advocacy skills. Behavior therapy is more helpful when used with medicine than it is when used by itself.
Counseling may help children and adults with ADHD recognize problem behaviors and learn ways to deal with them. For both parents and children, counseling can be a place to air frustrations and deal with stress.
Some children with ADHD also have other conditions, such as anxiety or oppositional defiant disorder. Behavioral therapy can help treat some of these conditions.7
Elementary school teachers are often the first to recognize ADHD symptoms because in the classroom more demands are placed on children to sit still, pay attention, listen, and follow class rules. Many times teachers recommend to parents that a child be tested or see a health professional.
Most children with ADHD qualify for educational services within the public schools. If your child qualifies, you will meet with school personnel to identify goals and establish an individualized education program (IEP). IEPs are based on the evaluation of a child's disability and his or her specific needs. This usually means your school will try to accommodate your child's extra needs, which may be as minor as placing him or her at the front of the class or as involved as providing classroom staff to assist your child.
Your doctor will talk with you about setting realistic and measurable goals for your child's behavior at school and at home. Each child must be considered individually, taking into account his or her specific problems and needs.
If your child is preschool age, your doctor may encourage behavioral therapy in an effort to curb symptoms and avoid using medicine at an early age. But if behavioral therapy is not effective in controlling symptoms, some doctors recommend medicines. Whether preschool-age children should receive medicine is somewhat controversial, because there are few studies in this age group. But the recently completed Preschool ADHD Treatment Study (PATS) has shown that the stimulant medicine methylphenidate (such as Ritalin) is safe and effective for preschool-age children.8
Recent research
- Although short-term studies have shown that stimulant medicines are safe, long-term effects have not been studied. In a recent 3-year study, children who took stimulant medicine grew almost 0.5 in. (1.3 cm) a year slower than children not on medicine. The study followed 540 youngsters with ADHD who were ages 7 to 9 at the start of the study. More studies are needed to determine whether growth is affected at other ages (younger than age 7, older than age 9) or whether children taking these medicines might catch up over a period of time.9, 10 As with any medicine, parents should think about not only the benefits their child might receive from these medicines but also the potential risks.
- In another part of the study, children who received medicine and behavior therapy did not have significantly greater improvement in core symptoms than those taking medicine only. But these children had some improvements in other areas, including less anxiety, better academic performance, and improved parent-child relations and social skills.11
- The study also looked at children who had ADHD in addition to another condition, such as conduct disorder or anxiety. Children who had ADHD and anxiety benefited from a combination of both medicine and behavior therapy.12
Ongoing treatment
Regular communication among parents, teachers, and doctors benefits a child who has attention deficit hyperactivity disorder (ADHD).
Teens will benefit from continuing to take a stimulant medicine—such as amphetamine (for example, Dexedrine, Adderall) or methylphenidate (for example, Ritalin, Concerta, Metadate CD, Focalin)—or nonstimulant atomoxetine (Strattera) if either type of medicine has been helpful in the past.
Parents can also be reassured that taking stimulant medication for ADHD does not increase the risk for substance abuse later. In fact, a recent analysis that followed children and teens with ADHD for at least 4 years found less alcohol and drug abuse in those who had taken stimulant medications than in those who did not receive medication.13 For more information, see:
Staying closely involved with your teen and continuing behavior therapy takes a lot of hard work but may pay off in the long run. The teen years present many challenges, including increased schoolwork and the need to be more attentive and organized. Making good decisions becomes especially important during these years when peer pressure, emerging sexuality, and other issues surface. Use consequences that are meaningful to your teenager, such as losing privileges or having increased chore assignments. Parents and teens can work together to establish reasonable, obtainable goals and negotiate appropriate rewards when those goals are met.
ADHD in adulthood
Attention deficit hyperactivity disorder (ADHD) often goes undiagnosed in adults. The right treatment can help those who have struggled with the condition for years. Like ADHD in children, adults may benefit from medication combined with psychological support, including education about the disorder, support groups and/or counseling, and skills training. Skills training can include time management, organizational techniques, and academic and vocational counseling.
Studies have found that about 58% of adults who have ADHD report a better ability to focus and less hyperactivity and impulsivity when taking stimulant medicines.14 If stimulant medicines have bothersome side effects or are not effective, your doctor might recommend atomoxetine (Strattera), a nonstimulant medicine. Strattera is not a controlled drug, which means refills and telephone prescriptions are allowed.
Certain antidepressants, such as bupropion (for instance, Wellbutrin), or tricyclics (for example, imipramine, nortriptyline, desipramine) are sometimes also recommended for adults with ADHD.
What To Think About
The U.S. Food and Drug Administration (FDA) has issued an advisory on Strattera. It suggests parents and other caregivers closely watch for warning signs of suicide in children and teens taking this medicine.15 The FDA does not recommend that people stop using this medicine. Instead, people who use this medicine should be watched for warning signs of suicide.
There are several myths that can interfere with a realistic perception of ADHD. It is important to understand that ADHD is a medical condition that cannot be consistently controlled without treatment. Help your child with ADHD to learn about the condition and the importance of following treatment plans. Your child is more likely to successfully control symptoms when he or she actively participates in treatment, such as taking medicines on time.
Some people use treatment methods that have not been proved helpful, such as diet restrictions. Do not substitute these practices for conventional medical treatment. Some treatments are potentially physically and emotionally harmful or unproved. Using them not only can be dangerous but may also prevent you from using proven methods of treatment. Talk with a doctor about the concerns or questions you or your child has about ADHD or its treatment.
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| Author: | Jeannette Curtis | Last Updated: April 17, 2008 |
| Medical Review: | Michael J. Sexton, MD - Pediatrics Mina Dulcan, MD - Child and Adolescent Psychiatry | |
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