ADHD- TREATMENT OPTIONS
There is no specific cure for ADHD, but many treatment options are available to manage the condition. In most cases, treatment of ADHD should include:
- Target outcomes for behavior
- Teamwork among doctors, parents, teachers, other caregivers, other health care professionals, and the child
- Parent training in behavioral management
- Behavioral school programs
- Medication
What are target outcomes?
Target outcomes are goals for your child. These should be specifically chosen to help your child function as well as possible at home, at school, and in your community. Some examples include:
- Improved relationships with parents, siblings, teachers, and friends (example: being invited more often to friends' houses)
- Better practices in schoolwork (example: completing all classwork or homework assignments)
- More independence in self-care and homework (example: getting ready for school in the morning without supervision)
- Fewer disruptive actions (example: decreasing the number of times they refuse to obey the rules)
- Safer behavior in the community (example: being careful when crossing the streets)
- Realistic
- Behaviors your child will be able to do
- Behaviors you can observe and count (with rating scales when possible)
Behavioral Therapy for ADHD
There are many forms of behavioral therapy, but all have a common goal- to change the child’s physical and social environments to help him improve his attention and activity.
3 basic principles of behavioral therapy:
- Set specific, doable goals (example: staying focused on homework for a certain amount of time)
- Provide rewards and consequences
- Give your child a specific reward (positive reinforcement) every time he demonstrates the desired behavior
- Give your child a consequence (unwanted result or punishment) consistently when he exhibits inappropriate behaviors
- Sometimes when you start a punishment, the behavior may first increase before it starts to decrease and disappear
- Continue to use the rewards and consequences- be consistent!
- Keep your child on a daily schedule (wake, eat, and sleep times should be consistent)
- Minimize distractions (keep screens off during meal and homework time and remove them from the bedroom; avoid overstimulating situations)
- Organize your house (have designated areas for your child to keep his schoolwork, toys, and clothes)
- Reward desired behavior (praise and reward your child's efforts to pay attention)
- Set small, reachable goals (use charts and checklists to track progress, keep instructions brief, offer frequent friendly reminders)
- Limit choices (only 2 or 3 options at a time)
- Find activities at which your child can succeed
- Use calm discipline (time out, removal from the situation, or ignoring behavior are all effective)
- Reach out to teachers (open communication is key!)
Studies have shown that medication alone or in conjunction with behavioral interventions is effective in treating ADHD. There are 2 major categories of medications: stimulants and non-stimulants. Most children are initially treated with stimulants, although there are reasons why some physicians may choose treatment with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different medications at different doses before finding the best choice.
Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. They come in long-acting (lasting 8-12 hours) or short-acting (2 or 3 doses per day lasting 3-4 hours each) preparations. Stimulant medications should be given at the same time of the day. Most parents will know if the dose of a stimulant medication is the best fit within 1 to 2 weeks of daily use. Non-stimulant medications may take up to 2 to 4 weeks of daily use before a beneficial effect is seen.
About 80 to 90% of children respond well to a stimulant medication. There is currently no way to know which medication will be the best fit for any particular child. Most physicians will start at the lowest dose of a medication and increase the dose to maximize the effectiveness of the dose while minimizing side effects. Stimulant medications are not dosed based on weight.
The medication (dosing) schedule may also be adjusted depending on the target outcome. For example, if the goal is to improve symptoms that mostly occur at school, your child may take the medication only on school days.
Medication Side Effects
Side effects tend to happen early in treatment and are usually mild and short-lived, but, in rare cases, they can be prolonged or more severe.
Stimulant side effects:
Most common :
1) Decreased appetite or weight loss
2) Sleep problems
3) Social withdrawal
4) Stomach ache or headache (when taken on an empty stomach)
Less common :
1) Rebound effect (increased activity or emotional lability/moodiness when the medication wears off)
2) Transient muscle movements or sounds (tics)
3) Minor growth delay
Very rare :
1) Significant increase in blood pressure or heart rate
2) Bizarre behaviors
3) Hallucinations
Non-stimulant side effects :
1) Drowsiness/fatigue/somnolence
2) Stomach ache/upset (cramping, diarrhea)
3) Decreased blood pressure (guanfacine, clonidine)
4) Rare: suicidal thoughts (strattera), liver damage (strattera)
More than half of children who have tic disorders, such as Tourette Syndrome, also have ADHD. Tourette Syndrome is a familial condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and a tic disorder in most cases. It is also possible to use atomoxetine or guanfacine for children with ADHD and Tourette Syndrome.
ADHD medications may not be an option for children who are taking certain other medications or have some medical conditions.
Most medication side effects can be relieved by:
- Changing the medication dose
- Adjusting the schedule of medication
- Using a different stimulant or trying a non-stimulant
Adapted from the American Academy of Pediatrics patient education booklet, “Understanding ADHD: Information for Parents About Attention Deficit/Hyperactivity Disorder”.
Additional information adapted from “Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians, 3 rd Edition”.
AAP Feed run on: 9/4/2024 Article information last modified on: 9/4/2024
ADHD- TREATMENT OPTIONS
There is no specific cure for ADHD, but many treatment options are available to manage the condition. In most cases, treatment of ADHD should include:
- Target outcomes for behavior
- Teamwork among doctors, parents, teachers, other caregivers, other health care professionals, and the child
- Parent training in behavioral management
- Behavioral school programs
- Medication
What are target outcomes?
Target outcomes are goals for your child. These should be specifically chosen to help your child function as well as possible at home, at school, and in your community. Some examples include:
- Improved relationships with parents, siblings, teachers, and friends (example: being invited more often to friends' houses)
- Better practices in schoolwork (example: completing all classwork or homework assignments)
- More independence in self-care and homework (example: getting ready for school in the morning without supervision)
- Fewer disruptive actions (example: decreasing the number of times they refuse to obey the rules)
- Safer behavior in the community (example: being careful when crossing the streets)
- Realistic
- Behaviors your child will be able to do
- Behaviors you can observe and count (with rating scales when possible)
Behavioral Therapy for ADHD
There are many forms of behavioral therapy, but all have a common goal- to change the child’s physical and social environments to help him improve his attention and activity.
3 basic principles of behavioral therapy:
- Set specific, doable goals (example: staying focused on homework for a certain amount of time)
- Provide rewards and consequences
- Give your child a specific reward (positive reinforcement) every time he demonstrates the desired behavior
- Give your child a consequence (unwanted result or punishment) consistently when he exhibits inappropriate behaviors
- Sometimes when you start a punishment, the behavior may first increase before it starts to decrease and disappear
- Continue to use the rewards and consequences- be consistent!
- Keep your child on a daily schedule (wake, eat, and sleep times should be consistent)
- Minimize distractions (keep screens off during meal and homework time and remove them from the bedroom; avoid overstimulating situations)
- Organize your house (have designated areas for your child to keep his schoolwork, toys, and clothes)
- Reward desired behavior (praise and reward your child's efforts to pay attention)
- Set small, reachable goals (use charts and checklists to track progress, keep instructions brief, offer frequent friendly reminders)
- Limit choices (only 2 or 3 options at a time)
- Find activities at which your child can succeed
- Use calm discipline (time out, removal from the situation, or ignoring behavior are all effective)
- Reach out to teachers (open communication is key!)
Studies have shown that medication alone or in conjunction with behavioral interventions is effective in treating ADHD. There are 2 major categories of medications: stimulants and non-stimulants. Most children are initially treated with stimulants, although there are reasons why some physicians may choose treatment with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different medications at different doses before finding the best choice.
Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. They come in long-acting (lasting 8-12 hours) or short-acting (2 or 3 doses per day lasting 3-4 hours each) preparations. Stimulant medications should be given at the same time of the day. Most parents will know if the dose of a stimulant medication is the best fit within 1 to 2 weeks of daily use. Non-stimulant medications may take up to 2 to 4 weeks of daily use before a beneficial effect is seen.
About 80 to 90% of children respond well to a stimulant medication. There is currently no way to know which medication will be the best fit for any particular child. Most physicians will start at the lowest dose of a medication and increase the dose to maximize the effectiveness of the dose while minimizing side effects. Stimulant medications are not dosed based on weight.
The medication (dosing) schedule may also be adjusted depending on the target outcome. For example, if the goal is to improve symptoms that mostly occur at school, your child may take the medication only on school days.
Medication Side Effects
Side effects tend to happen early in treatment and are usually mild and short-lived, but, in rare cases, they can be prolonged or more severe.
Stimulant side effects:
Most common:
1) Decreased appetite or weight loss
2) Sleep problems
3) Social withdrawal
4) Stomach ache or headache (when taken on an empty stomach)
Less common:
1) Rebound effect (increased activity or emotional lability/moodiness when the medication wears off)
2) Transient muscle movements or sounds (tics)
3) Minor growth delay
Very rare:
1) Significant increase in blood pressure or heart rate
2) Bizarre behaviors
3) Hallucinations
Non-stimulant side effects:
1) Drowsiness/fatigue/somnolence
2) Stomach ache/upset (cramping, diarrhea)
3) Decreased blood pressure (guanfacine, clonidine)
4) Rare: suicidal thoughts (strattera), liver damage (strattera)
More than half of children who have tic disorders, such as Tourette Syndrome, also have ADHD. Tourette Syndrome is a familial condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and a tic disorder in most cases. It is also possible to use atomoxetine or guanfacine for children with ADHD and Tourette Syndrome.
ADHD medications may not be an option for children who are taking certain other medications or have some medical conditions.
Most medication side effects can be relieved by:
- Changing the medication dose
- Adjusting the schedule of medication
- Using a different stimulant or trying a non-stimulant
Adapted from the American Academy of Pediatrics patient education booklet, “Understanding ADHD: Information for Parents About Attention Deficit/Hyperactivity Disorder”.
Additional information adapted from “Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians, 3rd Edition”.
AAP Feed run on: 9/4/2024 Article information last modified on: 9/4/2024
