Parenting a Child With ADHD - Treatment

What treatment has worked best for your child's ADHD?

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What treatment options exist for a child with ADHD?

Medical treatment

The two major components of treatment for children with attention deficit hyperactivity disorder (ADHD) are behavioral therapy and medication.

  • Home and school interventions: Parents can help their child's behavior with specific goals such as (1) maintaining a daily schedule, (2) keeping distractions to a minimum, (3) setting reasonable goals, (4) rewarding positive behavior, (5) using charts and checklists to keep a child "on task," and (6) finding activities in which the child will succeed (sports, hobbies). Children with ADHD may require adjustments in the structure of their educational experience, including tutorial assistance and the use of a resource room. Many children function well throughout the entire school day with their peers. However, some patients with ADHD will benefit from a "pull-out session" to complete tasks, review specific homework assignments, and develop "management" skills necessary for higher education. Extended time for class work/tests may be necessary as well as assignments written on the board and preferential seating near the teacher. An IEP (Individualized Educational Program) should be developed and reviewed periodically with the parents. ADHD is considered a disability falling under U.S. Public Law 101-476 (Individuals With Disabilities Education Act or IDEA). As such, individuals with ADHD may qualify for "appropriate accommodations within the regular classroom" within the public-school system. In addition, the Americans With Disabilities Act (ADA) indicates that secular private schools may be required to provide similar "appropriate accommodations" in their institutions.

  • Psychotherapy: ADHD coaching, a support group, or both can help teens feel more normal and provide well-focused peer feedback and coping skills. Counselors such as psychologists, child and adolescent psychiatrists, behavioral/developmental pediatricians, clinical social workers, and advanced practice nurses can be invaluable to both the children and families. Behavior modification and family therapy are usually necessary for the best possible outcome.

Medications

The medications used to treat ADHD are psychoactive. This means they affect the chemistry and the function of the brain.

Psychostimulants are by far the most widely used medications in treating ADHD. When used appropriately, approximately 80% of individuals with ADHD have a very good to excellent response in reduction of symptoms. These medications stimulate and increase activity of areas of the brain with neurotransmitter imbalances.

The exact mechanism of how these drugs relieve symptoms in ADHD is unknown, but these medicines are linked to increases in brain levels of the neurotransmitters dopamine and norepinephrine. Low levels of these neurotransmitters are linked to ADHD.

  • The most common adverse effects are short-term. They include reduction of appetite, sleep disturbances, rebound (for example, agitation, anger, lethargy as the last dose starts to wear off), and mild anxiety. Most individuals who take psychostimulants for ADHD build up tolerance to adverse effects within a few weeks.
  • Individuals with certain coexistent psychiatric disorders (for example, psychosis, bipolar disorder, some disorders of anxiety or depression) are particularly vulnerable to adverse effects if they do not receive appropriate concurrent treatment for the coexistent condition.

The psychostimulants most often used in ADHD include the following:

  • Methylphenidate (Ritalin, Concerta, Daytrana patch)
  • Dexmethylphenidate (Focalin, Folacin XR)
  • Dextroamphetamine and amphetamine mixture (Adderall, Adderall XR, Vyvance)

Atomoxetine (Strattera) is a newer nonstimulant used to treat ADHD. Less is known about its long-term side effects. This drug has several benefits over stimulants, but its use may also carry several negative aspects.

  • It is not a controlled substance and is not considered a drug of potential abuse by the U.S. Food and Drug Administration (FDA). Since it is not a controlled substance, pharmacies may accept phone-requested medical refills.
  • It is usually taken only once a day for full 24-hour effectiveness.
  • It is much less likely than stimulants to disrupt eating or sleeping.
  • For some children, atomoxetine is not enough to control their ADHD symptoms. Many other children do very well on this medicine alone.
  • Specialists treating individuals with ADHD have found Strattera seems to best help improve the problems associated with a disruption in executive function skills. Inattention and hyperactivity symptoms are less responsive.
  • When starting atomoxetine therapy, a gradually increasing dosage schedule is recommended. It may take up to three weeks before full therapeutic benefit is achieved. For this reason, patients may need to remain on previously prescribed stimulant medication during the "build up" phase. In addition, atomoxetine must be taken daily; short-term "medication holidays" (for example, school vacations and weekends) will limit its efficacy.
  • Studies have indicated a higher than expected incidence of suicide ideation during early treatment. This occurred in patients with pure ADHD as well as in those patients with ADHD accompanied by other emotional disorders (for example, depression, anxiety, bipolar disorder).

Some medications originally developed to treat depression (antidepressants) also have important roles in treating some individuals with ADHD. Since these medicines have been used for many years to treat other mental-health conditions, their adverse effects are well understood.

  • Imipramine (Tofranil): an antidepressant that increases levels of neurotransmitters norepinephrine and/or serotonin in the brain

  • Bupropion (Wellbutrin): an antidepressant that increases levels of neurotransmitters in the brain, especially dopamine

  • Desipramine (Norpramin): an antidepressant that increases levels of the neurotransmitter norepinephrine in the brain

Other medicines that were originally developed to treat high blood pressure (alpha agonists) may also be useful in the treatment of those having ADHD. Again, due to widespread and long-term use, their side effects are well known to doctors.

  • Clonidine (Catapres): an a2 agonist that stimulates certain receptors in the brain stem. The overall effect is to "turn down the volume" of hyperactive movement and speech.
  • Guanfacine (Tenex, Intuniv): another alpha agonist with an effect similar to that of clonidine. These medications are designed to be used in combination with other medications listed above. They are not effective when taken as a single and only medication.
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