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 medication and/or behaviour therapy to treat children with ADHD. This recommendation, which is also followed in Canada, 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 medication had a significant decrease in core ADHD symptoms (inattention, impulsivity, and hyperactivity).6
Your child's health professional may recommend that your child take a stimulant medication, such as amphetamine (examples include Dexedrine or Adderall XR) or methylphenidate (examples include Ritalin or Concerta). These medications 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 medications, when taken correctly, do not cause dependence. However, parents should closely supervise the use of ADHD medications, 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 medications to assess whether they are receiving the correct dose. These side effects usually decrease after a few weeks on the medication, or the dosage can be lowered to offset them. For more information, see:
Atomoxetine (Strattera) is a non-stimulant medication that may be prescribed if stimulant medications are not effective or have bothersome side effects. Strattera is not a controlled drug, allowing refills on prescriptions and telephone prescriptions.
The AAP guidelines also encourage behaviour therapy. Through behaviour therapy, parents learn strategies, such as positive reinforcement, to improve a child's behaviours. Children learn to develop problem solving, communication, and self-advocacy skills. Behaviour therapy is more helpful when used with medication than by itself.
Counselling may help children and adults with ADHD recognize problem behaviours and learn ways to deal with them. For both parents and children, counselling can serve to air frustrations and deal with stress.
Some children with ADHD also have other conditions, such as anxiety or oppositional defiant disorder. Behavioural 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.
Under federal and provincial laws, some children with ADHD qualify for educational services within the public schools. Children often need to have ADHD and learning disabilities to qualify. If your child qualifies, you will meet with school personnel to identify goals and establish an individualized education program (IEP). IEPs are based upon 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 health professional will talk with you about setting realistic and measurable goals for your child's behaviour 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 health professional may encourage behavioural therapy in an effort to curb symptoms and avoid using medication at an early age. However, if behavioural therapy is not effective in controlling symptoms, some health professionals recommend medications. Whether preschool-aged children should receive medication is somewhat controversial, because there are few studies in this age group. However, the recently completed Preschool ADHD Treatment Study (PATS) has shown that the stimulant medication methylphenidate (such as Ritalin) is safe and effective for preschool-age children.8
Recent research
- Although short-term studies have shown that stimulant medications are safe, long-term effects have not been studied. In a recent 2-year study, children who took stimulant medication grew almost 1.5 cm (0.5 in.) per year slower than children not on medication. The study followed 540 youngsters with ADHD who were ages 7 to 9 at the outset 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 medications might catch up over a period of time.9 As with any medication, parents should balance the benefits their child might receive from these medications with any potential risks.
- In another study, children who received medication and behaviour therapy did not have significantly greater improvement in core symptoms than those taking medication only. However, these children saw some improvements in other areas, including a decrease in anxiety, better academic performance, and improved parent-child relations and social skills.10
- A study was done with 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 medication and behaviour therapy.11
Ongoing treatment
Regular communication among parents, teachers, and health professionals benefits a child with attention deficit hyperactivity disorder (ADHD).
Teens will benefit from continuing to take a stimulant medication—such as amphetamine (for example, Dexedrine or Adderall XR) or methylphenidate (examples include Ritalin or Concerta)—or non-stimulant atomoxetine (Strattera) if either type of medication 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.12 For more information, see:
Staying closely involved with your teen and continuing behaviour therapy takes a lot of hard work but may pay off in the long run. The teen years present many challenges, including increased school work 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
Unfortunately, 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 counselling, and skills training. Skills training can include time management, organizational techniques, and academic and vocational counselling.
Studies have found that about 58% of adults with ADHD report a better ability to focus and less hyperactivity and impulsivity when taking stimulant medications.13 If stimulant medications have bothersome side effects or are not effective, your doctor might recommend atomoxetine (Strattera), a non-stimulant medication. Strattera is not a controlled drug, allowing refills and telephone prescriptions.
Certain antidepressants, such as bupropion (for instance, Wellbutrin), or tricyclics (such as imipramine, nortriptyline, and desipramine) are sometimes also recommended for adults with ADHD.
What To Think About
Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on Strattera. They suggest parents, families, and other caregivers closely watch for warning signs of suicide in all people who take this medicine.14, 15 Health Canada and the FDA do not recommend that people stop using this medicine, but to watch for warning signs of suicide in those using it.
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 medications on time.
Some people use treatment methods that have not been proven helpful, such as diet restrictions. Do not substitute these practises for conventional medical treatment. Some treatments are potentially physically and emotionally harmful or unproven. Using them not only can be dangerous but may also prevent you from using proven methods of treatment. Talk with a health professional about any concerns or questions you or your child has about ADHD or its treatment.
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| Author: | Carrie Henley Sabra L. Katz-Wise | Last Updated: August 31, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Mina Dulcan, MD - Child and Adolescent Psychiatry Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics | |
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