Attention Deficit Hyperactivity Disorder: Treatment Overview

Treatment of ADHD helps control the ADHD symptoms, including inattention, hyperactivity, and impulsivity. Consistent ADHD treatment can improve the ability of the person with ADHD to function better in school, at work, and in social situations.

Treatment for ADHD is multifaceted. It consists of ADHD medications or behavioral modification therapy or both. ADHD treatment should be tailored to meet the unique needs of the child or adult who has ADHD as well as the needs of the family. What kind of treatment for ADHD is recommended for children and adolescents?

Studies have established the safety and effectiveness of using stimulant medications, other drugs, and behavioral therapy. These treatments do more than simply relieve the symptoms of ADHD. They also improve the child's ability to follow rules and to improve relationships with peers and parents.

There are two treatment strategies that have been shown to be effective for elementary-school children with ADHD. The first is a closely monitored medication treatment program. The second is a program that combines medication with intensive behavior therapy. In a large study, nine out of 10 children improved substantially with one of these two treatment strategies.

The most effective approach to treatment for children and adolescents with ADHD is a multidisciplinary approach. This approach includes multiple elements that work best together and support each other. The components of a multidisciplinary approach to treating ADHD include:

* education for both parents and child about diagnosis and treatment * ADHD medication

* behavior management therapy

* school teacher involvement

* school counselor involvement

Which medications are used to treat ADHD in children?

The primary ADHD medications include stimulants, nonstimulants, and antidepressants.

Stimulants are the most common treatment for ADHD in children and adolescents. They include methylphenidate -- Ritalin, Metadate, Concerta -- or amphetamines, including Dexedrine, Dextrostat, and Adderall. A newer drug, Vyvanse, is a type of amphetamine that’s formulated to last longer and to be less conducive to dependence than other stimulants.

Other FDA-approved drugs for ADHD in children and adolescents include the nonstimulants Strattera and Intuniv. Strattera works on levels of the brain chemical norepinephrine and is quite effective at treating and controlling ADHD symptoms. Intuniv affects certain receptors in the brain and also improves concentration and impulse control. Both of these drugs pose a much lower risk of abuse or dependence than stimulants.

The antidepressant Wellbutrin has been shown to be beneficial in treating ADHD. Wellbutrin can be an alternate treatment when tolerance or abuse of a stimulant is a problem.

Antidepressants have a positive effect on all three of the major components of ADHD: inattention, impulsivity, and hyperactivity. They are another option for children whose response to stimulant medication has been inadequate. They also are used as an alternative for children who experience unacceptable side effects, such as tics or insomnia, from stimulant medication.

Studies have shown there are different types of antidepressant medications that can be useful in treating ADHD. They include:

* Tricyclic antidepressants are helpful in both children and adults with ADHD. These antidepressants are also relatively inexpensive. They can, though, cause some unpleasant side effects, such as dry mouth, constipation, or urinary problems. Examples of tricyclic antidepressants include:

o Pamelor

o Aventyl

o Tofranil

o Norpramin

o Pertofrane

Wellbutrin is very effective in treating ADHD in adults and children. It is generally well-tolerated. It also has some side effects that may be a problem with people who have anxiety, headaches, or seizures.

* SSRIs are "Prozac type" drugs. Lexapro and Zoloft, for example, are SSRIs that have been tried.

* Effexor and Effexor XR are newer antidepressants. They increase the levels of norepinephrine and serotonin in the brain. The drugs are effective at improving mood and concentration in adults as well as children and teens.

* MAO inhibitors are a group of antidepressants that can treat ADHD. But they are rarely used because they have significant and sometimes dangerous side effects. They can also interact dangerously with foods and other medications. They may be beneficial for people for whom other medications have failed. Examples include Nardil or Parnate.

Stimulant medications may be combined with an antidepressant medication for some children. The combination seems to work well for the child who has both ADHD and a condition such as an anxiety disorder, depression, or another mood disorder.

Catapres and guanfacine are drugs normally taken to treat high blood pressure. They also have been shown to be of some benefit for ADHD. Sometimes they're used alone or sometimes in combination with stimulant drugs. The drugs can improve mental functioning as well as behavior in people with ADHD.

Do ADHD medications have side effects?

ADHD drugs sometimes have side effects. But these usually occur when treatment is started and are usually mild and short-lived. The most common side effects of stimulants for ADHD include:

* decreased appetite/weight loss

* sleep problems

* headaches

* jitteriness

* social withdrawal

* stomachaches

* acne

Nonstimulant drugs may cause upset stomach, abdominal pain, headaches, fatigue, sleepiness, and other symptoms.

Antidepressants have a potential for side effects such as heart-rate and rhythm changes, dry mouth, headaches, and drowsiness. Use of these drugs requires more careful monitoring.

In most cases, your doctor can control the side effects of ADHD medications with one of the following strategies:

* changing the medication dosage

* adjusting the schedule of medication

* using a different medication

If your child has side effects with an ADHD medication, call your doctor. Do not make any changes in the prescribed treatment without talking to the doctor first.

Rarely, medications for ADHD cause serious side effects. For instance, some stimulants are associated with an increased risk of cardiovascular problems and sudden death in children. They may also exacerbate psychiatric conditions, like depression or anxiety. The nonstimulant Strattera has been associated with an increased risk of suicidal thinking in teenagers. So make sure you talk to a doctor about all of the potential risks before you -- or your child -- start using a new drug for ADHD.

How does behavioral treatment work for ADHD?

Some forms of behavior therapy have little effectiveness in treating ADHD patients. But one type of behavioral management therapy can be used with success. This approach to ADHD treatment can be used with or without medications.

With behavioral management therapy, a licensed mental-health professional -- psychologist, social worker, or family therapist -- will work with both you and your child's teacher. The therapist will train you in child behavior management.

You and the teacher will be taught to see the child's behavior as a function of ADHD -- rather than as negative behavior. The sessions are meant to teach you to focus on appropriate behavior. At the same time, you learn to ignore minor inappropriate behavior.

You will also learn to give clear and concise directions and to establish effective incentive programs. The incentive programs may use rewards like tokens, tickets, or reward points. Then you and the teacher manage your child's behavior. You do that by applying immediate and consistent consequences in the form of rewards or taking privileges away.

The elements of behavioral management therapy include:

* Goal-setting -- You and the teacher help your child learn to set and accomplish specific goals. Examples of goals include completing a chore, finishing a classroom assignment, playing amicably with a peer on the playground, sitting at his desk for an hour or more.

* Rewards and consequences -- Your child receives his or her due -- rewards or consequences -- for his or her actions. For example, additional computer time can be given for good behavior or achieving established goals. Negative behavior can be met with time out or loss of privileges.

* Consistent therapy for a long period of time -- It's important to use goal-setting, rewards, and consequences with your child until the child adopts these behavioral changes as his own.

Guidelines from the American Academy of Pediatrics (AAP) recommend medication, behavior therapy, or both to treat children with ADHD. One study by the National Institute of Mental Health (NIMH) found, though, that individuals with ADHD who had behavioral treatment alone had fewer or less prominent ADHD symptoms.

As you seek safe and effective treatment for your child's ADHD, remember that treatment needs to be tailored to your child's specific needs. Always talk to your doctor about what's best for your child.

Can ADHD be treated with dietary changes or vitamins?

In the past, experts and parents of ADHD children hoped that dietary changes -- no food dye, no sugar, and no salicylates -- could cure ADHD. Some experts championed megadoses of vitamins and natural dietary supplements as a possible "cure" for ADHD. Some parents claimed that a gluten-free diet helped to cure ADHD or improve the symptoms.

There's no denying that a well-balanced diet is most important for optimal health. But scientific studies do not support the idea that dietary factors or a vitamin deficiency actually causes ADHD.

How is ADHD treated in adults

Adults with ADHD also benefit from a multidisciplinary approach to treatment. That approach includes:

* cognitive behavioral therapy (CBT)

* medication

* support and education, including marital and individual support groups

* skill training Stimulant mediations are the most commonly used ADHD treatment in adults. In fact, about 58% of adults with ADHD say they have a better ability to focus and less hyperactivity and impulsivity when they take stimulant medications.

If stimulant medications have bothersome side effects or are not effective, your doctor might recommend atomoxetine (Strattera), a non stimulant medication.

Certain antidepressants, such as bupropion (Wellbutrin), or tricyclics (imipramine, nortriptyline, and desipramine) are sometimes also used for adults with ADHD.

Source: WEBMD