Treatment

As is the case with many other chronic diseases such as diabetes and asthma, the current goal for treatment of ADHD is not a cure but instead to manage the disorder or reduce the symptoms.15,23

  • The current philosophy advocates a multimodal approach using pharmacological and psychosocial treatments combined with supportive management/environmental manipulation and family support strategies.2,16,28,32
    • Peer group placement is an example of environmental manipulation. A small study from the University of Michigan reported that children with ADHD can focus better and become less distracted after just a single 20-minute session of exercise.26
    • Parents play a major role in the treatment of a child’s ADHD. Parental training can include help giving clear instruction to the child and appropriate use of positive and negative reinforcement. Since this disorder impacts the rest of the family, all family members need guidance in how to negotiate or solve problems associated with raising and managing a child with ADHD.2,16
  • According to the American Academy of Pediatrics, physicians should routinely titrate doses of medications for ADHD to achieve maximum benefit with minimum adverse effects.1
    • Parents must enforce a specific daily drug regimen designed to increase the child’s attention span, complete tasks and maintain interest. Adherence to such a course of therapy provides the child with the greatest chance of acceptance with themselves, friends and society.16
  • In addition, since genetics is an important factor in the disorder, be aware that the parent may be struggling with their own ADHD.
  • Psychosocial treatments are beneficial in the management of ADHD symptoms.15 A widely used technique is behavior management training which includes contingency management, positive/negative reinforcement and time out.15 These strategies, which are most effective with preschool or grade school aged children, can be easily taught to parents and teachers in an individual or group setting.15 Since many children with ADHD have deficits in social skills, training is often employed, in a group setting, to encourage appropriate social interactions. As the child becomes old enough to engage in ‘talk therapy’, individual or family therapy may be useful in targeting symptoms such as low self-esteem or demoralization.15
  • Academic accommodations are typically necessary and include preferential seating, untimed testing and incentives for remaining on task.15
  • While some religions and parents may be hesitant to ‘drug a child’ pharmacological treatments are warranted to control symptoms.
    • Stimulant drugs are most frequently used to treat ADHD.17 These medications inhibit dopamine and norepinephrine reuptake in the brain, which results in increased attention and concentration and reduced hyperactivity and impulsivity. These actions serve to increase a child’s mood; decrease motor activity, aggressive behavior and anxiety; and improve the ability to focus attention and concentration.18
      • Methylphenidate is one of the most commonly prescribed medications to treat ADHD.18 Methylphenidate comes in a number of forms including short acting pills, long acting pills, chewable tablets, liquids, and skin patches. Long-term use of methylphenidate in pre-pubertal children may be associated with growth suppression expressed as weight loss and limited height growth.18 A ‘drug holiday’ – interruption of treatment – is often suggested on weekends and summers to allow the child to ‘catch up’ growth.18 Additional side effects may include insomnia, stomachaches and headaches.18 Methylphenidate is a short acting stimulant, usually lasting 3-4 hours. Short acting stimulants risk having a “rebound” effect on attention and mood when the medication wears off. This may result in extreme irritability between doses.15
      • Concerta is an extended release form of methylphenidate, lasting up to 8-12 hours and is less likely to produce this ‘rebound effect’.15
      • Other CNS stimulants such as dextroamphetamine (Dexedrine), amphetamine/dextroamphetamine (Adderall), and lisdexamfetamine dimesylate (Vyvanse) may be prescribed to patients with ADHD.15,25
    • Two antihypertensive medications which modulate norepinephrine activity, clonidine (Catapres, Duraclon, Kapvay, Nexiclon) and guanfacine (Tenex, Ituniv) are commonly utilized to treat for patients with ADHD.25
    • Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor which can improve all three core symptoms of ADHD – inattention, hyperactivity and impulsivity.19
    • Bupropion (Wellbutrin) is a norepinephrine-dopamine reuptake inhibitor, typically used as an antidepressant, which can also be used to target symptoms of inattention in patients with ADHD.
      • Both atomoxetine and bupropion carry an FDA black box warning for the potential for increased suicidal thinking in children and young adults.