Treatment of Attention Deficit Hyperactivity Disorder Mental Disorder Network Attention Deficit Hyperactivity Disorder

Treatment of Attention-Deficit Hyperactivity Disorder

Treating attention-deficit hyperactivity disorder can be a challenging proposition involving medications, psychological treatment, nutrition and lifestyle changes. Many parents also find themselves consulting with school district personnel, not just health care professionals. Given the extraordinary incompetence and corruption in some school districts, they may be a hindrance rather than an aid.

No single treatment is the answer for every individual. Certain medications may produce undesirable side effects in some patients. Adults may require different medications or doses than children. Attention-Deficit Hyperactivity Disorder can also be complicated by other illnesses, some of which produce very similar symptoms. Parents of children who have ADHD will not want to limit their research to a single article, no matter how thorough.

The results of a study conducted by the National Institute of Mental Health (the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder) indicate that long-term combination treatments (medication and behavioral therapy) and medication-management alone are superior to intensive behavioral treatment and routine community treatment. (In routine community care, the children saw a community-treatment doctor, who didn’t interact with the teachers, one to two times per year for short periods of time.) In some areas—anxiety, academic performance, oppositionality, parent-child relations, and social skills—the combined treatment was usually superior.

Another advantage of combined treatment was that children could be successfully treated with lower doses of medicine, compared with the medication-only group.

Medication

Medications don’t cure Attention-Deficit Hyperactivity Disorder; they only control the symptoms on the day they are taken. The most effective are a class of drugs known as stimulants. Below is a list of the stimulants, their trade (or brand) names, and their generic names. "Approved age" means that the drug has been tested and found safe and effective in children of that age.

Trade Name Generic Name Approved Age
Adderall amphetamine 3 and older
Concerta methylphenidate (long acting) 6 and older
Cylert* pemoline 6 and older
Dexedrine dextroamphetamine 3 and older
Dextrostat dextroamphetamine 3 and older
Focalin dexmethylphenidate 6 and older
Metadate ER methylphenidate (extended release) 6 and older
Metadate CD methylphenidate (extended release) 6 and older
Ritalin methylphenidate 6 and older
Ritalin SR methylphenidate (extended release) 6 and older
Ritalin LA methylphenidate (long acting) 6 and older

*Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first-line drug therapy for ADHD.

The stimulant drugs are usually considered quite safe when used with medical supervision. However, there have been many complaints about Ritalin. Some people complain that certain health care providers or government officials are too quick to prescribe Ritalin. There are also many web sites that broadcast Ritalin horror stories. Keep in mind, however, that the people who complain the loudest aren’t necessarily medical experts.

The U.S. Food and Drug Administration (FDA) recently approved a medication for ADHD—Strattera®, or atomization—that is not a stimulant.

A new biological diagnosis for AD/HD announced in January 2005 may also predict how patients are likely to respond to drugs.

Beyond Medicine

Behavioral therapy, emotional counseling, and practical support help ADHD children cope with everyday problems and feel better about themselves. Mental health professionals can counsel children and their families alike, helping them to develop new skills, attitudes, and ways of relating to each other.

Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. Behavioral therapy (BT) helps people develop more effective ways to work on immediate issues. Social skills training can also help children learn new behaviors.

Support groups help parents connect with other people who have similar problems and concerns with their ADHD children. Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child’s behavior.

Parents may also learn to use stress management methods, such as meditation, relaxation techniques, and exercise, to increase their own tolerance for frustration so that they can respond more calmly to their child’s behavior.

Public Schools: Friend or Foe?

Children with ADHD may qualify for special education, but this can be a two-edged sword. Many public schools can be likened to dysfunctional families themselves, and it’s very possible that your child’s teacher could be taking anti-depressants.

See our special report on Public Education vs Mental Health.

Long Term Outlook

About 80 percent of children who need medication for ADHD still need it as teenagers. Over 50 percent need medication as adults. Several studies done in recent years estimate that 30-70 percent of children with ADHD continue to exhibit symptoms as adults.