Optimal treatment for ADHD is still a matter of debate. Current treatments typically involve therapy, medication or both. However, recent research indicates that a combination of therapy and medication may be the most helpful treatment.
Counseling therapies may include:
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Another medication that works in a similar manner, but is not a stimulant, is atomoxetine (Strattera). Sometimes antidepressants also may be used — especially for adults and for children who don't respond to stimulants or who are depressed or have other problems.
These medications are available in short-acting and long-acting forms. The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours. With the exception of methylphenidate, these medications come only in an oral form. Methylphenidate was recently introduced in a long-acting — about nine hours — patch that can be worn on the hip. This form was approved for use in children between the ages of 6 and 12 under the brand name Daytrana.
Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of the brain chemicals called neurotransmitters.
These ADHD medications help alleviate the core signs and symptoms of inattention and hyperactivity — sometimes dramatically. However, effects of the drugs wear off quickly. Additionally, the right dose varies between individuals, so it may take some time in the beginning to find the dose that's right for you or your child.
There's been some concern about using medications to treat preschoolers who have ADHD. One large-scale study found that low doses of the commonly used medications are safe and effective in young children. However, the study did find that the younger children were more susceptible to medication side effects.
Medication side effects
A small percentage of children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.
The nonstimulant medication Strattera has been linked to side effects that include rare liver problems. If your child is taking Strattera and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact your doctor right away. In September 2005, the Food and Drug Administration (FDA) issued a public health warning to doctors about the risk of suicidal thinking in children and adolescents being treated with Strattera. The FDA urged doctors to closely observe children being treated with Strattera for signs of suicidal thinking.
Adderall has raised concerns because of reports of sudden unexplained deaths in children taking the medication. Health officials in Canada suspended sales of Adderall XR in February 2005, but allowed the drug back on the market in August 2005 after recommending that the drug not be used in children with heart abnormalities. In the United States, the FDA also is recommending that the medication not be used in anyone with known cardiac abnormalities.
Dextroamphetamine has also raised concerns because sudden deaths in youngsters with heart abnormalities have occurred. The drug may also cause troubling psychological side effects, such as delusional thoughts or hallucinations.
Parents also are understandably concerned about psychostimulants — which are similar to amphetamines — and the risk of addiction. But dependence hasn't been reported in children who take medications orally and at the proper dosage. That's because drug levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse ADHD medications.
In general, psychostimulant side effects in adults are similar to those in children. But ADHD drugs are also more likely to cause certain problems specifically in adults, including mild increases in blood pressure that may be significant for people who already have hypertension, and the liver disease hepatitis. In addition, because adults usually require higher dosages of these medications than children do, the risk of abuse or addiction may be greater. Antidepressants, either alone or in combination with a psychostimulant, can help reduce mood instability and disturbances. Side effects may include dry mouth, urinary retention, weight gain, drowsiness and sexual dysfunction.
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