Treatment for attention-deficit hyperactivity disorder (ADHD) varies, depending on a number of factors, including the type and severity of the condition, the child's age, and whether the child has any co-existing medical conditions. ADHD treatment may involve medication or behavioral therapyand often involves a combination of both.
No single treatment works best for every child. So if your child has been diagnosed with ADHD, it is important to work with his or her health care team to develop an effective ADHD treatment plan.
Treatment for children who have ADHD often involves medications. Stimulants usually are the first-line medications prescribed. If two or three stimulants are tried and found to be ineffective, or the child does not tolerate the medication well, non-stimulants or antidepressants may be used.
Stimulants do not cure ADHD, but they can help control symptoms. In fact, studies have shown that these medications can improve symptoms in 7090 percent of children who have ADHD. Stimulants increase production of dopamine, which is a chemical in the brain that improves communication between cells (called a neurotransmitter). Increased dopamine levels help to reduce impulsivity and hyperactivity and improve attention.
Some stimulants are approved for use in children as young as 3 years of age, and some are approved for use in children over the age of 6. These medications are available in short-acting forms (last 35 hours), intermediate forms (last 38 hours), and long-acting forms (last 812 hours).
Types of stimulants used to treat attention-deficit hyperactivity disorder include amphetamine (e.g., Adderall, Adderall XR), dextroamphetamine (e.g., Dexedrine, Dextrostat, Focalin), and methylphenidate (e.g., Concerta, Ritalin, Ritalin SR, Ritalin LA, Metadate ER, Metadate CD).
Although stimulants are considered safe when used as directed, studies have shown that they may increase the risk for severe cardiovascular problems (e.g., heart attack, abnormal heart rate, stroke) in a small number of children. Stimulants should only be used under the supervision of a qualified health care provider and children should take the smallest dose possible to control ADHD.
Many stimulant side effects are mild and are related to the dosage. Some children report that they feel "different" or "strange" while taking these medications. Parents should monitor the child closely during treatment and should report any worrisome side effects to their child's physician. Common side effects of stimulants include the following:
- Difficulty sleeping (insomnia)
- Loss of appetite (appetite may fluctuate, often lower in the middle of the day)
- Stomach ache
Although stimulants are usually the first medications prescribed to treat ADHD, non-stimulants (e.g., Intuniv, Strattera)also may be used. These medications can improve attention and reduce impulsivity, hyperactivity, and distractibility in people with attention-deficit hyperactivity disorder. Non-stimulants do not carry a risk for dependence, their effects often are longer-lasting when compared to stimulants, and they usually do not cause agitation or difficulty sleeping.
In September 2009, guanfacine hydrochloride (Intuniv) was approved by the U.S. Food and Drug Administration (FDA) to treat attention-deficit hyperactivity disorder in children and adolescents 617 years of age. This medication is used as part of an overall ADHD treatment plan that also may include psychological, social, and educational measures. It is usually prescribed for 8 to 9 weeks, and longer use has not been studied.
Intuniv is an alpha-adrenergic receptor agonist that is administered once daily as an extended-release tablet. Due to increased absorption of the medication, the tablets should not be crushed, broken, or chewed, and should not be taken with high-fat meals. The usual dosage ranges from 14 mg per day.
Possible side effects of guanfacine hydrochloride may include the following:
- Abdominal pain
- Dry mouth
- Excessive sleepiness (somnolence)
- Low blood pressure (hypotension)
Studies have shown that Intuniv can help reduce symptoms of ADHDat home and at school. In many children, behaviors associated with attention-deficit hyperactivity disorder begin to improve within 2 weeks. To reduce the risk for adverse reactions caused by the abrupt discontinuation of Intuniv abruptly, this drug should be gradually tapered.
Atomoxetine HCl (Strattera) is also approved by the FDA to treat ADHD in children. Strattera increases levels of the neurotransmitter norepinephrine, which helps to improve attention.
Side effects of Strattera include the following:
- Abdominal pain
- Dizziness (vertigo)
- Loss of appetite
- Nausea and vomiting
Strattera may increase the risk for suicide in a small number of children and adolescents. Children who are taking this medication should be monitored closely for mention of suicidal thoughts and behavior (suicidality), worsening of symptoms, or unusual changes in behavior.
ADHD that does not respond to stimulants or non-stimulants may be treated using antidepressants in some cases. Antidepressants that may be prescribed include tricyclic antidepressants (e.g., nortriptyline, Tofranil, Norpramine), bupropion (e.g., Wellbutrin), and venlafaxine (e.g., Effexor XR).
Side effects of antidepressants include the following:
- Dry mouth
- Upset stomach
Many children with ADHD are successfully treated using a combination of medical treatment (i.e., medication) and behavioral therapy. In behavioral therapy, parents, caregivers, and medical professionals (e.g., psychotherapists) use different strategies to help the child modify his or her behavior.
Behavioral therapy for ADHD often involves reorganizing the child's environment (e.g., at home and at school), making sure that the child receives clear instructions, and implementing a system of rewards for desirable behavior and consequences for undesirable behavior.
The involvement of parents and caregivers is crucial to the success of behavioral therapy. Behavior modification strategies that may be helpful for children and adolescents with ADHD include the following:
- Encourage the child to follow the same schedule every day.
- Set clear goals (e.g., "Get dressed by 8:00 a.m.).
- Help the child keep his or her belongings (e.g., school books, toys, clothing) in the same place.
- Teach the child to avoid unnecessary distractions (e.g., television, computer games) while working.
- Limit the number of choices offered to the child (e.g., allow him or her to choose between two food items rather than a long list).
- Give the child brief directions and instructions.
- Reward the child's efforts and positive behavior.
- Take away privileges as a consequence of undesirable behavior.
When parents and caregivers use a rewards system, it is important that they remember that love, affection, and praise should be offered to the child unconditionally, and not only as a reward for good behavior.
Parents, other family members, and children who have ADHD may benefit from attending a support group, where they can connect with others who have similar concerns and problems. Psychotherapy may help children and adolescents with attention-deficit disorder accept their condition and find new ways to handle emotions and explore and improve behavior.