Attention Deficit- Hyperactivity Disorder (ADHD)
How is it treated?
ADHD is a complex condition that can mimic other disorders; therefore, diagnosis plays a crucial role in the disorder. A physical exam by a doctor will help rule out physical illness such as a thyroid disorder, hunger, constipation, infection, or other disorders that could cause hyperactivity or inattentiveness. After the diagnosis of ADHD is made, options for treatment should begin with behavioral therapy and medication. Sometimes behavioral therapy is used alone but most often it is a combination of behavioral and medication therapies that are most effective.
The behavioral therapies include dividing large assignments into smaller more manageable tasks, giving the child rewards for completing certain tasks, speaking with a therapist, finding a support group, and manipulating situations to benefit the child's needs. Giving the child no time limits while taking a test, seating the child away from as many distractions as possible, and giving the child less homework may benefit a child with ADHD. To learn more about behavioral therapies, click on the "Helping Yourself" link above.
Medication is also a first-line option, but should typically not be used without behavioral therapy. At this time there are only a few medications that are approved for the treatment of ADHD. One class of drugs is called stimulants, and they work to improve concentration and allow the child or adult to focus on activities. This drug class includes dextroamphetamine (Dexedrine) and methylphenidate (Ritalin). Stimulants have been shown in studies to be effective in children with ADHD, with 70%-95% of children responding positively. If one stimulant medication does not work, another in the same class should be tried. The effects of long-term treatment with stimulants are not completely understood. It does not appear that stimulants stunt the growth of children as was previously thought. It is recommended that treatment with stimulants be reevaluated every year. Some unwanted effects from stimulants may be increased jitteriness, and decreased appetite; these effects tend to diminish over time with repeated use. Additional adverse effects may occur if more than the prescribed dose is taken, or use is not closely monitored by a healthcare professional.
Recently, drug companies have been making newer longer acting formulations of stimulant drugs. This includes a newly developed skin patch containing methylphenidate that can be worn on the hip. The patch, called Daytrana, is approved for use in children aged 6 to 12 and carries the same side effects as other methylphenidate medications. These new longer-acting medications are helpful because they allow ADHD medication to be dosed just once a day. This also avoids the problem of children having to take a dose of their medication while in school.
A more recent drug available for the treatment of ADHD is atomoxetine (Straterra). Atomoxetine is a non-stimulant medication that has been shown to be effective in children and adults with ADHD. It is currently considered a second line agent, and used after two unsuccessful treatment attempts with stimulants.
Antidepressants are another class of drugs that are used when treating ADHD. Antidepressants are considered second-line therapy to be used in patients that have ADHD with depression or when the stimulants are not working. Tricyclic antidepressants work in the body to prevent the nerves from taking up the chemicals such as dopamine and norepinephrine believed to be low in the brain in ADHD. The medication allows these chemicals to stay around longer in the blood and be used by the body in a more productive manner. Two tricyclic antidepressants are sometimes used to treat ADHD -- imipramine and desipramine. There are other medications that have been used for the treatment of ADHD but are not approved by the FDA. This type of treatment is called "off-label" use. These drugs include bupropion, clonidine, and guanfacine.
To learn more about first-line drug therapies for ADHD, click on the link below.
Drug classes used to treat Attention Deficit- Hyperactivity Disorder (ADHD) Selective Norepinephrine Reuptake Inhibitor Stimulants
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How is it treated?
