Treatments for Attention Deficit Hyperactivity Disorder
Treatment list for Attention Deficit Hyperactivity Disorder: The list of treatments mentioned in various sources for Attention Deficit Hyperactivity Disorder includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Lifestyle changes
- Supportive treatments
Treatment of Attention Deficit Hyperactivity Disorder: medical news summaries: The following medical news items are relevant to treatment of Attention Deficit Hyperactivity Disorder:
- ADHD diagnosis in children is not followed by adequate monitoring
- ADHD drug linked to sudden unexplained deaths in children
- ADHD medication highlighted heart disorder
- ADHD medication may be linked to adult depression
- ADHD overdiagnosed in children by unqualified people
- Diet the key to curing ADHD problems claim author
Treatments of Attention Deficit Hyperactivity Disorder discussion: The usual course of treatment may include medications such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine) or pemoline (Cylert), which are stimulants that decrease impulsivity and hyperactivity and increase attention. Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Treatment should include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child. 1
Many parents have tried nutritional methods, such as taking sugar out of the child's diet, before they seek medical attention. A small body of research has suggested that some children may benefit from nutritional treatments, but there are no well-established methods that have consistently shown to be helpful to most children with ADHD. Monitoring a child's diet gets more difficult as a child gets older and more independent, making effective research difficult. Also, delaying the use of proven, effective treatments, and trying things with unknown effects is likely to be harmful for many children. 2
There are various forms of behavioral treatments used for children with ADHD, including psychotherapy, cognitive-behavioral therapy, social skills training, support groups, and parent and educator skills training. An example of very intensive behavior therapy was used in the Multimodal Treatment Study of Children with ADHD (MTA), sponsored by the National Institute of Mental Health (NIMH). In the study, the child's teacher and the family participated in an all-day, 8-week summer camp. The camp aimed to improve social behavior, academic work, and sports skills. The therapist worked with teachers to develop behavior management strategies to help behavioral problems interfering with classroom behavior and academic performance. A trained classroom aide worked with the child for 12 weeks in his or her classroom to provide support and reinforcement for appropriate, on-task behavior. Parents met with the therapist alone and in small groups to learn ways for handling problems at home and school. 2
Psychostimulant medications, including methylphenidate (Ritalin®) and amphetamines (Dexedrine®, Dextrostat®, and Adderall®), are by far the most widely researched and commonly prescribed treatments for ADHD. Several short-term studies have proven the safety and effectiveness of stimulants and psychosocial treatments for helping the symptoms of ADHD. Again, NIMH research has found that the two most effective treatment methods for elementary school children with ADHD are a closely monitored medication treatment and a treatment that combines medication with intensive behavioral interventions. In the MTA study, which included nearly 600 elementary school children across multiple sites, nine out of ten children greatly improved on one of these treatments.
Antidepressant medications also may be used as a second line of treatments for children who show poor response to stimulants, who have unacceptable side effects, or who have other conditions with ADHD (such as tics, anxiety, or mood disorders). Clinical studies have shown that these drugs are effective in 60-70% of children with ADHD. While the medications were extremely helpful to most children, MTA study results show that medications alone may not be the best way to treat many children. For example, children who had other problems (e.g., anxiety, stressful home circumstances, lack of social skills, etc.), over and above the ADHD symptoms, seemed to benefit most from the combined treatment. 2
Careful medication management is important in treating a child with ADHD. The doctor is likely to begin with a low dose to test the child's response. For methylphenidate (Ritalin®), the usual dosage range is 5 to 20 mg given two to three times a day. The dose for amphetamines (Dexedrine® and Dextrostat® and Adderall®) is one-half the methylphenidate dose. Dosage requirements do not always correlate with weight, age or severity of symptoms in an individual patient. Some doctors prescribe a combination of medications. Dosages may need to be increased during childhood with increased lean body weight and decreases may be necessary after puberty. Different doctors use these medications in slightly different ways, and different children may respond differently to each medication. 2
The expected duration of treatment has increased during this past decade as evidence has grown that shows benefits extend into adolescence and adulthood. However, many factors make it hard for adolescents to continue using medications: once on medication, adolescents see their most obvious symptoms controlled, and think they don't need to take it regularly. The medications' short-lasting effects make it necessary to take them several times per day, although there are newer long-term medications now being offered. Parents often get frustrated with the limited results or side effects of the medication, and discontinue its use. 2
For decades, medications have been used to treat the symptoms of ADHD. Three medications in the class of drugs known as stimulants seem to be the most effective in both children and adults. These are methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). For many people, these medicines dramatically reduce their hyperactivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as handwriting and ability in sports. Recent research by NIMH suggests that these medicines may also help children with an accompanying conduct disorder to control their impulsive, destructive behaviors.
Ritalin helped Henry focus on and complete tasks for the first time. Dexedrine helped Mark to sit quietly, focus his attention, and participate in class so he could learn. He also became less impulsive and aggressive. Along with these changes in his behavior, Mark began to make and keep friends.
Unfortunately, when people see such immediate improvement, they often think medication is all that's needed. But these medicines don't cure the disorder, they only temporarily control the symptoms. Although the drugs help people pay better attention and complete their work, they can't increase knowledge or improve academic skills. The drugs alone can't help people feel better about themselves or cope with problems. These require other kinds of treatment and support.
For lasting improvement, numerous clinicians recommend that medications should be used along with treatments that aid in these other areas. There are no quick cures. Many experts believe that the most significant, long-lasting gains appear when medication is combined with behavioral therapy, emotional counseling, and practical support. Some studies suggest that the combination of medicine and therapy may be more effective than drugs alone. NIMH is conducting a large study to check this3
Stimulant drugs, such as Ritalin, Cylert, and Dexedrine, when used with medical supervision, are usually considered quite safe. Although they can be addictive to teenagers and adults if misused, these medications are not addictive in children. They seldom make children "high" or jittery. Nor do they sedate the child. Rather, the stimulants help children control their hyperactivity, inattention, and other behaviors.
Different doctors use the medications in slightly different ways. Cylert is available in one form, which naturally lasts 5 to 10 hours. Ritalin and Dexedrine come in short-term tablets that last about 3 hours, as well as longer-term preparations that last through the school day. The short-term dose is often more practical for children who need medication only during the school day or for special situations, like attending church or a prom, or studying for an important exam. The sustained-release dosage frees the child from the inconvenience or embarrassment of going to the office or school nurse every day for a pill. The doctor can help decide which preparation to use, and whether a child needs to take the medicine during school hours only or in the evenings and on weekends, too.
Nine out of 10 children improve on one of the three stimulant drugs. So if one doesn't help, the others should be tried. Usually a medication should be tried for a week to see if it helps. If necessary, however, the doctor will also try adjusting the dosage before switching to a different drug.
Other types of medication may be used if stimulants don't work or if the ADHD occurs with another disorder. Antidepressants and other medications may be used to help control accompanying depression or anxiety. In some cases, antihistamines may be tried. Clonidine, a drug normally used to treat hypertension, may be helpful in people with both ADHD and Tourette's syndrome. Although stimulants tend to be more effective, clonidine may be tried when stimulants don't work or can't be used. Clonidine can be administered either by pill or by skin patch and has different side effects than stimulants. The doctor works closely with each patient to find the most appropriate medication.
Sometimes, a child's ADHD symptoms seem to worsen, leading parents to wonder why. They can be assured that a drug that helps rarely stops working. However, they should work with the doctor to check that the child is getting the right dosage. Parents should also make sure that the child is actually getting the prescribed daily dosage at home or at school--it's easy to forget. They also need to know that new or exaggerated behaviors may also crop up when a child is under stress. The challenges that all children face, like changing schools or entering puberty, may be even more stressful for a child with ADHD.
Some doctors recommend that children be taken off a medication now and then to see if the child still needs it. They recommend temporarily stopping the drug during school breaks and summer vacations, when focused attention and calm behavior are usually not as crucial. These "drug holidays" work well if the child can still participate at camp or other activities without medication.
Children on medications should have regular checkups. Parents should also talk regularly with the child's teachers and doctor about how the child is doing. This is especially important when a medication is first started, re-started, or when the dosage is changed. 3
As useful as these drugs are, Ritalin and the other stimulants have sparked a great deal of controversy. Most doctors feel the potential side effects should be carefully weighed against the benefits before prescribing the drugs. While on these medications, some children may lose weight, have less appetite, and temporarily grow more slowly. Others may have problems falling asleep. Some doctors believe that stimulants may also make the symptoms of Tourette's syndrome worse, although recent research suggests this may not be true. Other doctors say if they carefully watch the child's height, weight, and overall development, the benefits of medication far outweigh the potential side effects. Side effects that do occur can often be handled by reducing the dosage. 3
Several intervention approaches are available and different therapists tend to prefer one approach or another. Knowing something about the various types of interventions makes it easier for families to choose a therapist that is right for their needs.
Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change. However, people dealing with ADHD usually want to gain control of their symptomatic behaviors more directly. If so, more direct kinds of intervention are needed.
Cognitive-behavioral therapy helps people work on immediate issues. Rather than helping people understand their feelings and actions, it supports them directly in changing their behavior. The support might be practical assistance, like helping Henry learn to think through tasks and organize his work. Or the support might be to encourage new behaviors by giving praise or rewards each time the person acts in the desired way. A cognitive-behavioral therapist might use such techniques to help a belligerent child like Mark learn to control his fighting, or an impulsive teenager like Lisa to think before she speaks.
Social skills training can also help children learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to "read" other people's facial expression and tone of voice, in order to respond more appropriately. Social skills training helped Lisa learn to join in group activities, make appropriate comments, and ask for help. A child like Mark might learn to see how his behavior affects others and develop new ways to respond when angry or pushed.
Support groups connect people who have common concerns. Many adults with ADHD and parents of children with ADHD find it useful to join a local or national support group. Many groups deal with issues of children's disorders, and even ADHD specifically. The national associations listed at the back of this booklet can explain how to contact a local chapter. Members of support groups share frustrations and successes, referrals to qualified specialists, and information about what works, as well as their hopes for themselves and their children. There is strength in numbers--and sharing experiences with others who have similar problems helps people know that they aren't alone.
Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child's behavior. One such technique is the use of "time out" when the child becomes too unruly or out of control. During time outs, the child is removed from the agitating situation and sits alone quietly for a short time to calm down. Parents may also be taught to give the child "quality time" each day, in which they share a pleasurable or relaxed activity. During this time together, the parent looks for opportunities to notice and point out what the child does well, and praise his or her strengths and abilities.
An effective way to modify a child's behavior is through a system of rewards and penalties. The parents (or teacher) identify a few desirable behaviors that they want to encourage in the child--such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn't. A reward can be small, perhaps a token that can be exchanged for special privileges, but it should be something the child wants and is eager to earn. The penalty might be removal of a token or a brief "time out." The goal, over time, is to help children learn to control their own behavior and to choose the more desired behavior. The technique works well with all children, although children with ADHD may need more frequent rewards.
In addition, parents may learn to structure situations in ways that will allow their child to succeed. This may include allowing only one or two playmates at a time, so that their child doesn't get overstimulated. Or if their child has trouble completing tasks, they may learn to help the child divide a large task into small steps, then praise the child as each step is completed.
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. 3
Here are a few types of treatment that have not been scientifically shown to be effective in treating the majority of children or adults with ADHD:
- restricted diets
- allergy treatments
- medicines to correct problems in the inner ear
- chiropractic adjustment and bone re-alignment
- treatment for yeast infection
- eye training
- special colored glasses
A few success stories can't substitute for scientific evidence. Until
sound, scientific testing shows a treatment to be effective, families risk
spending time, money, and hope on fads and false promises.3
1. excerpt from NINDS Attention Deficit-Hyperactivity Disorder Information Page: NINDS
2. excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC
3. excerpt from Attention Deficit Hyperactivity Disorder: NIMH
Last revision: July 1, 2003
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