There is no "cure" for ADHD, however, many treatment approaches may alleviate or significantly decrease ADHD symptoms. As a result, improvements are evident in school/work performance, relationships with others improve, and self esteem increases.
No single treatment works for every individual. Treatment options should be explored with a health care provider who will consider the patient's needs, and family, medical, and personal history. Some people respond well to medications, some to behavioral interventions, many respond to a combination of the two. Counseling, education, and support services are often helpful. Typically, a multimodal approach to treatment works best.
Medications
Stimulant medication or non-stimulant medication may be prescribed. Management with medication was shown to be the most cost-effective, followed by behavioral treatment and combined treatment in a 14 month follow-up study. However, a follow-up study found that stimulant medication offered no benefits over behavioral therapy in children after their respective treatments allocations had been discontinued for two years.
A 2007 drug class review found that there are no good studies of comparative effectiveness between various drugs for ADHD and that there is a lack of quality evidence on their effects on overall academic performance and social behaviors.
ADHD medications are not recommended for preschool children as their long term effects in such young people are unknown. There is very little data on the long-term adverse effects or benefits of stimulants for ADHD.
A 2007 drug class review found that there are no good studies of comparative effectiveness between various drugs for ADHD and that there is a lack of quality evidence on their effects on overall academic performance and social behaviors.
ADHD medications are not recommended for preschool children as their long term effects in such young people are unknown. There is very little data on the long-term adverse effects or benefits of stimulants for ADHD.
Stimulant medication
Ritalin (methylphenidate) 10 mg tablets (AU)
Stimulants are the most commonly prescribed medications for ADHD. The most common stimulant medications are the chain subsitituted amphetamine methylphenidate (Ritalin, Metadate, Concerta), dextroamphetamine (Dexedrine), mixed amphetamine salts (Adderall), dextromethamphetamine (Desoxyn) and lisdexamfetamine (Vyvanse).
However, caution needs to be used when prescribing medications that increase levels of "feel-good" neurotransmitters like dopamine, because they can be addictive (see article: amphetamine dependence). According to several studies, use of stimulants (e.g. methylphenidate) can lead to development of drug tolerance to therapeutic doses; tolerance also occurs among high dose abusers of methylphenidate.
However, caution needs to be used when prescribing medications that increase levels of "feel-good" neurotransmitters like dopamine, because they can be addictive (see article: amphetamine dependence). According to several studies, use of stimulants (e.g. methylphenidate) can lead to development of drug tolerance to therapeutic doses; tolerance also occurs among high dose abusers of methylphenidate.
Stimulants used to treat ADHD raise the extracellular concentrations of the neurotransmitters dopamine and norepinephrine which causes an increase in neurotransmission. The therapeutic benefits are due to noradrenergic effects at the locus coeruleus and the prefrontal cortex and dopaminergic effects at the nucleus accumbens.
A meta analysis of clinical trials found that about 70% of children improve after being treated with stimulants in the short term but found that this conclusion may be biased due to the high number of low quality clinical trials in the literature.
There have been no randomized placebo controlled clinical trials investigating the long term effectiveness of methylphenidate (Ritalin) beyond 4 weeks. Thus the long term effectiveness of methylphenidate has not been scientifically demonstrated. Serious concerns of publication bias regarding the use of methylphenidate for ADHD has also been noted.
There have been no randomized placebo controlled clinical trials investigating the long term effectiveness of methylphenidate (Ritalin) beyond 4 weeks. Thus the long term effectiveness of methylphenidate has not been scientifically demonstrated. Serious concerns of publication bias regarding the use of methylphenidate for ADHD has also been noted.
Higher rates of schizophrenia and bipolar disorder as well as increased severity of these disorders occur in individuals with a past history of stimulant use for ADHD in childhood. Emergency room visits by children ages 10–14 involving Ritalin intoxication have now reached the same level as those for cocaine which indicates escalating abuse of this highly addictive drug.
US and Canada account for a startling 95 percent of worldwide Ritalin consumption. In one study which looked at adult cocaine users, it was found that those individuals who used Ritalin between one and ten years of age had a percentage of cocaine abuse twice that of those who had been diagnosed with ADHD but had not utilized Ritalin.
US and Canada account for a startling 95 percent of worldwide Ritalin consumption. In one study which looked at adult cocaine users, it was found that those individuals who used Ritalin between one and ten years of age had a percentage of cocaine abuse twice that of those who had been diagnosed with ADHD but had not utilized Ritalin.
Both children with and without ADHD abuse stimulants, with ADHD individuals being at the highest risk of abusing or diverting their stimulant prescriptions. Between 16 and 29 percent of students who are prescribed stimulants report diverting their prescriptions. Between 5 and 9 percent of grade/primary and high school children and between 5 and 35 percent of college students have used nonprescribed stimulants. Most often their motivation is to concentrate, improve alertness, "get high," or to experiment.
Although one review indicates that long-term use of methylphenidate has potential for abuse and addiction due to its similar pharmacologically to cocaine and amphetamines. Some other doctors argue that use of stimulant therapy for ADHD does not increase the risk of subsequent substance abuse and may be protective against it when treatment is started in childhood. However, when stimulant therapy is started during adolescence or adulthood, there is an increased risk of subsequent substance abuse.
One study found that children with ADHD actually need to move more to maintain the required level of alertness while performing tasks that challenge their working memory. Performing math problems mentally and remembering multi-step directions are examples of tasks that require working memory, which involves remembering and manipulating information for a short time.
These findings may also explain why stimulant medications improve the behavior of most children with ADHD. Those medications improve the physiological arousal of children with ADHD, increasing their alertness. Previous studies have shown that stimulant medications temporarily improve working memory abilities.
These findings may also explain why stimulant medications improve the behavior of most children with ADHD. Those medications improve the physiological arousal of children with ADHD, increasing their alertness. Previous studies have shown that stimulant medications temporarily improve working memory abilities.
Although "under medical supervision, stimulant medications are considered safe", the use of stimulant medications for the treatment of ADHD has generated controversy because of undesirable side effects, uncertain long term effects and social and ethical issues regarding their use and dispensation.
The FDA has added black-box warnings to some ADHD medications, while the American Heart Association and the American Academy of Pediatrics feel that it is prudent to carefully assess children for heart conditions before treating them with stimulant medications.
The FDA has added black-box warnings to some ADHD medications, while the American Heart Association and the American Academy of Pediatrics feel that it is prudent to carefully assess children for heart conditions before treating them with stimulant medications.
A novel stimulant drug that has been used to treat ADHD is modafinil. There have been double-blind randomized controlled trials that have demonstrated the efficacy and tolerability of modafinil, however there are risks of serious side effects such as skin reactions and modafinil is not recommended for use in children.
Antipsychotic medication
Risperdal (risperidone) 4 mg tablets (UK)
In an odd contrast with the approved use of stimulant medication as a treatment for children with ADHD, the use of atypical antipsychotic drugs as an off-label treatment has been rising. Antipsychotics work by blocking dopamine, whereas stimulants trigger its release.
Atypical antipsychotics have been approved for use in children and teenagers with schizophrenia spectrum disorders and autistic spectrum disorders by the U.S. Food and Drug Administration (FDA) since 1993.
Atypical antipsychotics have been approved for use in children and teenagers with schizophrenia spectrum disorders and autistic spectrum disorders by the U.S. Food and Drug Administration (FDA) since 1993.
Non-ADHD children do not respond differently to ADHD children when prescribed antipsychotic drugs, which are also increasingly prescribed off-label for children with aggression or defiant behavior. Social pressure to control a child's difficult and disruptive behavior, both at home and at school, may inadvertently change focus from what is in the best interest of the child's wellbeing; to how to render the child more compliant and easier to manage.
Careful approach needs to be taken when blocking dopamine function, which is responsible for the psychological reward system. Excessive blocking of this neurotransmitter can cause dysphoria. This may in turn cause suicidal ideation, or lead some teenagers to compensate for their dopamine deficiency with illicit drugs or alcohol.
Atypical antipsychotics are preferred for this reason, because they are less likely to cause movement disorders, dysphoria, and increased drug cravings that have been associated with older typical antipsychotics.
Weight gain, diabetes, lactation, gynecomastia, drooling, dysphoria, anhedonia (inability to experience pleasure), fatigue, sexual dysfunction, heart rhythm problems and the possibility of tardive dyskinesia, an irreversible movement disorder, are among the adverse events associated with antipsychotic drugs.
Atypical antipsychotics are preferred for this reason, because they are less likely to cause movement disorders, dysphoria, and increased drug cravings that have been associated with older typical antipsychotics.
Weight gain, diabetes, lactation, gynecomastia, drooling, dysphoria, anhedonia (inability to experience pleasure), fatigue, sexual dysfunction, heart rhythm problems and the possibility of tardive dyskinesia, an irreversible movement disorder, are among the adverse events associated with antipsychotic drugs.
Other non-stimulant medications
Atomoxetine (Strattera) and Guanfacine (Intuniv) are the only non-stimulant drugs approved for the treatment of ADHD. Other medications which may be prescribed off-label include α2A adrenergic receptor agonists such as clonidine, certain antidepressants such as tricyclic antidepressants, SNRIs, SSRIs or MAOIs.
More about medications:
Stimulant Medications and Safety Issues
ECG Monitoring for ADHD Children
Reducing Side Effects of Medicine
Medication Guide for Parents
Medication Vacations
Stimulant Medications and Safety Issues
ECG Monitoring for ADHD Children
Reducing Side Effects of Medicine
Medication Guide for Parents
Medication Vacations
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