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Attention Deficit Hyperactivity Disorder Treatment overview While there is currently no cure for ADHD, there are many treatment options that can help those with the disorder focus, modify their impulsive or hyperactive behavior so as to function more effectively, and improve self-esteem. The latest research indicates that the most successful remedy is often a "multi-modality" plan that includes a combination of behavioral therapy and medication. It is important that the chosen treatments be tailored to a patient's needs. In most cases, treatment will include:
It is essential for parents to be educated about ADHD, to inform all those involved in their child's life about the condition, and to encourage constant, consistent communication among these interested parties. This section contains more information on:
Behavioral therapy Once a diagnosis of ADHD is made, treatment usually includes behavioral modification, with the main goal being to increase the frequency of appropriate actions and decrease the frequency and severity of inappropriate conduct. Generally speaking, this involves adjusting a child's environment to promote more successful social interactions--first and foremost, by creating additional structure and encouraging routines. Indeed, children with ADHD perform and respond best in an ordered, predictable setting, both at home and school. They need clear, consistent, and simple rules that are easy to understand and follow. When they do follow these rules, they should be rewarded; consequences need to be established ahead of time and delivered immediately. A very important part of treatment--teaching the child to operate in his or her own environment and to find his or her own successful coping strategies--can begin in elementary school. This section provides more on:
Behavioral modification at home Parents can help their children develop organizational skills and an ability to follow through on tasks, as well as discourage impulsive behavior, in a positive way by communicating clear, consistent expectations and limits and setting up an effective discipline system that rewards when appropriate and imposes immediate consequences when necessary. One popular technique is to create charts using icons or words that outline out a few specific tasks or chores and rewards for their successful completion, and note accomplishments along the way. In order to teach new behavior, it is important to "catch the child being good." Punishment alone only teaches a child what not to do. Other methods parents can try:
Behavioral modification in the classroom Children with ADHD often struggle in school, not because they can't handle the work but because they can't concentrate on their lessons and have trouble following instructions. They frequently miss important pieces of information and forget or lose assignments because of poor organizational abilities. When the condition is severe enough to significantly impact performance, a youngster with the disorder may qualify for educational accommodations provided under a federally mandated 504 plan, such as extended time on tests and note-taking support. Others might qualify for special education services under the category of Other Health Impaired, or OHI. The exact form of educational assistance or special services children receive will depend on the nature and severity of their condition. Even if the child does not qualify for accommodations, parents may find that cooperative teachers would rather work with them on ways to develop better focus and organizational skills than simply discipline a child for constantly seeming to fool around. A teacher might seat the child in the front row and tap her on the shoulder when she seems to daydream, for example, and might be willing to break complex sets of instructions or assignments into discrete steps. In addition, parents might want to hire a tutor with special expertise in ADHD to help a child master better study and organizational skills. Medications A number of drugs have been approved to treat ADHD. But it's important to note that none of these medications cure the condition--they enable the child or adult to better control his or her attention and behavior. To that end, the patient and his or her family must work closely with the physician to:
A drug is selected by determining:
You and an older child or adolescent should discuss the choice of medicine with the doctor, reviewing the pros and cons of different options. Patients who do not respond to an ADHD medication can usually be prescribed a different drug. If no drugs are found to be beneficial, the doctor and the patient's family must investigate further. It's possible that the ADHD diagnosis may be wrong, or that the patient may have another disease that is interfering with drug therapy. This section contains more information on:
Stimulants The largest class of drugs for the treatment of ADHD is the stimulants, which work by arousing the parts of the brain that are responsible for organization and management. Specifically, they increase levels of the neurotransmitter dopamine. Neurotransmitters are chemicals in the brain that transmit nerve impulses. Stimulant medications are the most effective type of drug at helping patients' focus, and 70 to 80 percent of patients with combined ADHD and inattentive ADHD are treated effectively with them, with the former having the most predictable response. The stimulant drugs include the following:
Children who take a stimulant medication will usually see an effect on their symptoms--an improved ability to concentrate and less impulsivity--within an hour. The "regular" or short-acting versions of ADHD drugs typically have to be taken every three to four hours. Stimulants that are designated as "extended release," "controlled release," "intermediate-acting," or "long-acting" take longer to break down in the body, so a patient may take only one pill during the day to last six to 12 hours. Because each person's reaction to drugs is different, the dosage and scheduling of an ADHD medication must be adapted specifically for each patient. As with all drugs, stimulants can have side effects, though they tend to happen early in treatment and are usually mild and short lived. They include:
A small number of sudden deaths and nonfatal heart attacks and strokes in people taking stimulants have raised concerns about the drugs, and people with heart problems and high blood pressure are cautioned about taking them. Parents will benefit by working with a doctor who has known a child for some time before prescribing ADHD medicine, and has knowledge of any structural heart abnormalities (such as heart murmurs). Conscientious doctors also will want to observe whether a child has an adverse response to medicine after it is introduced. It should be noted that millions of people take stimulants safely, and that the incidence of life-threatening adverse events is extremely small. Moreover, a causal relationship between the drugs and the adverse reactions has not been established. A small percentage of children who take stimulants develop tics, which are involuntary movements of various muscles, usually in the face and hands. Side effects can often be managed by changing dosages, adjusting the dosing schedule, or by switching to a long-acting version of the drug or a different medication altogether. Some parents worry that children who take stimulant drugs may be at greater risk of becoming addicted to drugs in general. Although newspapers often run stories of, say, Ritalin abuse among college students, the fact is that studies have shown that stimulants do not cause a greater risk of drug abuse as children get older. In fact, the opposite appears to be true: Children who do not take medication for their ADHD symptoms have been shown to have a greater risk of developing a substance-abuse problem later in life as they try to self-medicate. Non-stimulants Not all patients are able to choose stimulant medications for ADHD. They may have contraindications to these drugs; children with heart defects are steered away from stimulants, for example. Or they may have tried the medications and found them to be ineffective or experienced troublesome side effects. A newer, nonstimulant option is amoxetine (Strattera), which works on the neurotransmitter norepinephrine. Patients usually have to take Strattera for up to three weeks before seeing any effects on symptoms. However, it's important to note that last year the FDA issued a warning about the increased risk of suicidal thinking in children and adolescents taking Strattera. Your doctor can address any questions or concerns. Other medication options Other medications that are prescribed for ADHD for use alone or with stimulants include the blood pressure drugs clonidine (Catapres) and guanfacine (Tenex). These medicines can "calm" patients down and help reduce hyperactivity and insomnia symptoms in children with ADHD. In addition, they may decrease the incidence of tics and help children better manage anger. There are also several types of antidepressant drugs that are used to treat ADHD, including:
Such drugs affect the neurotransmitters dopamine and norepinephrine but may take up to three weeks to take full effect. They are sometimes used as the initial treatment for those who also suffer from significant depression. However, this class of drugs is generally not as effective as stimulants or the newer nonstimulant treatments at improving attention span and concentration. Further, last year the FDA warned that antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders, so it's important to discuss any questions or concerns with your doctor. The FDA is in the process of approving Modafinil (Sparlon), a drug used to treat sleep conditions like narcolepsy and sleep apnea, for children and teens with ADHD. Psychological counseling Psychological counseling will not cure ADHD, but it can be extremely helpful in managing symptoms and is an important part of any treatment plan. Therapy can help parents learn to provide an appropriate, stress-free environment for homework completion, for example, and also help children and their families deal more effectively with the social and emotional aspects of ADHD. A big danger for children with the condition is that the feeling of constantly screwing up--and of disappointing or angering Mom and Dad and their teachers--fosters low self-esteem, anxiety, and depression. Parents' acceptance of the various symptoms as part of who the child is goes a long way in treating ADHD. Alternative treatments Alternative approaches are sometimes used to treat ADHD:
Before you commit to an alternative treatment, it's wise to ask whether there's any scientific evidence that it's effective. Treating adults with ADHD As with children and adolescents, the most effective treatment is a multi-modality plan that includes medication and behavioral therapy. Adults with ADHD may be helped by stimulants, and if not, they are sometimes prescribed antidepressants. These drugs work by affecting the neurotransmitters dopamine and norepinephrine but may take up to three weeks to take full effect. Adults who take medications for ADHD have different requirements than children. For instance, adults probably need a smaller dosage because the drug may stay in their systems longer. Another consideration is that an adult is more likely than a child to have other conditions and therefore may already be taking other medications. The physician has to take this into consideration when prescribing ADHD drugs that may interact with other medications. Adult ADHD may also be treated with one or more of the following:
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