Treatment of ADHD

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.

Therapy:
Children and adults with ADHD often greatly benefit from counseling or behavior therapy, which may be provided by a psychologist or other mental health care professionals. Some people with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.

Counseling therapies may include:

  • Psychotherapy. This allows older children and adults with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
  • Behavior therapy. This type of therapy helps teachers and parents learn strategies (contingency management procedures) for dealing with children's behavior. These strategies may include token reward systems and timeouts. Behavior modification using contingency management techniques has proved especially beneficial for people with ADHD.
  • Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
  • Social skills training. This can help children learn appropriate social behaviors.
  • Support groups. Support groups can offer adults and children with ADHD and their parents a network of social support, information and education.
  • Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.

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.

Medications
Drugs known as psychostimulants are the most commonly prescribed medications for treating ADHD in children and adults. Commonly used psychostimulants include:

  • Methylphenidate (Ritalin, Concerta)
  • Dextroamphetamine/amphetamine (Adderall)
  • Dextroamphetamine (Dexedrine)

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
The most common side effects of psychostimulants in children include decreased appetite, corresponding weight loss, nervousness and problems sleeping. Some children experience irritability or increased activity as the effect of the medication tapers off. Adjustments in doses can often offset these 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.

Experimental treatments
Behavior therapies and medications are the most thoroughly researched treatments for ADHD. Other approaches are being studied but are still considered to be unproved and experimental.

  • Biofeedback. Ordinarily, this stress-reduction technique is used to help people learn to control certain body responses, such as heart rate and muscle tension. It has also been used with the intent of teaching adults and children with ADHD to change their brain wave patterns to more normal ones.
  • Brain wave biofeedback. The goal of brain wave biofeedback (Neurobiofeedback) is to teach people to control their own brain wave patterns using electroencephalography (EEG) feedback, sometimes combined with a video game. EEG measures the waves of electrical activity of the brain.
  • Special diets and supplements. Over the years, a great deal of media attention has focused on diets for ADHD. Most diets involve eliminating additives and foods thought to increase hyperactivity, such as sugar and caffeine, and common allergens such as wheat, milk and eggs. So far, however, studies haven't found a consistent link between diet and improved symptoms of ADHD. If you think certain foods affect your child's behavior, however, try eliminating them for a time. Additionally, there's no evidence that dietary supplements, such as fatty acids, ginkgo or megadoses of vitamins, can reduce ADHD symptoms.

 
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