The best approach to treating ADHD is not only with medicine but also with concomitant psychosocial therapy. Because the population diagnosed with ADHD is composed mainly of the younger demographic, the American Academy of Pediatrics has set guidelines for evidence-based medical treatment of children in specific age groups.
However, before we delve into that, let us first talk about the general class of medication that is used for the treatment of ADHD: stimulants.
Medical Treatment
Although it may sound counterintuitive to administer stimulants to already hyperactive and inattentive children and adults, there is a deeper science and reason to this. Drugs that treat ADHD have recently been found to target two areas of the brain: the prefrontal cortex and the nucleus accumbens. These function respectively as the executive control center and the reward center. How stimulants work, in simple terms, is it increases the concentration of two chemical messengers in the brain, dopamine, and norepinephrine. Dopamine works in memory formation whereas norepinephrine is involved in attention, working memory, and decision making. So, instead of the child self-stimulating themselves, they hand over the reins to the stimulants, so they no longer have to stimulate themselves. Putting two and two together, it is now evident why doctors use stimulants to treat ADHD, and that is simply to streamline the attention of the child or adult.
As with all medication, there is always potential for side effects. Stimulants used for ADHD such as Adderall and Ritalin may produce uncomfortable side effects such as sleeping problems, weight problems, mood swings and changes, and tics. At this point, it is best to seek advice from your doctor as to what steps to take from here on out.
The American Academy of Pediatrics has split the guidelines of medical and behavioral treatment according to two age groups in children, and a separate group for adolescents.
- Preschool-aged children (4-5 years of age) are recommended to undergo behavioral therapy first without medication (as in parent-training programs) as their ADHD has been proven to improve significantly when treated behaviorally at this stage. However, if the behavioral therapy does not improve the child’s core symptoms, it is advisable to take methylphenidate.
- Elementary school-aged children (6-11 years of age) are recommended to take medication approved by the FDA in the form of stimulants, as well as engage in behavioral therapy administered by either the parent or the teacher.
Specifically, because stimulants are a probable source of drug addiction, the American Academy of Pediatrics has put forward medications with little to no abuse potential.
- Adolescents (12-18 years of age) should first be checked for substance abuse. If the adolescent is not into substance abuse, it is safe to administer atomoxetine, extended use guanfacine, and extended use of clonidine, as these are all medications with no abuse potential.
- Medications with little abuse potential also include lisdexamfetamine and dermal methylphenidate.
To give you a bird’s eye view of the medications available for ADHD, the medications will be presented in tabular form.
|
Generic Name |
Brand Name |
Approved Age |
Abuse Potential |
|
Methylphenidate |
Ritalin Ritalin SR Ritalin LA Concerta Metadate Quillivant |
Above 6 years old |
Low |
|
Dextroamphetamine |
Dexeridin |
Above 3 years old* |
Low |
|
Dextroamphetamine and Amphetamine |
Adderall |
Above 3 years old |
|
|
Lisdexamfetamine |
Vyvanse |
Above 6 years old |
Low |
|
Extended Release Guanfacine |
Intuniv XR |
Above 12 years old |
None |
|
Extended Release Clonidine |
Kapvay |
Above 12 years old |
None |
|
Atomoxetine |
Strattera |
Above 12 years old |
None |
*Dextroamphetamine, the only FDA approved drug for the treatment of ADHD for children below six years old, has been found by the American Academy of Pediatrics to be approved based on less stringent criteria rather than on evidence-based studies on safety and efficacy in this preschool age group.
It is important to note that these drugs are given at low dosages to maximize the attention effects of the drug; if not, a high dose of these may do the opposite. I.e., instead of promoting the ability to streamline attention, it reduces the signal processing of the brain.
Behavioral Treatment
It has already been noted that it is best your child receives behavioral therapy along with medical therapy to improve his symptoms of ADHD. This is known as the multimodal treatment approach.
Majority of this behavioral therapy comes in the form of behavioral parent training or BPT where parents are taught by a mental health professional. Usually, BPT is done in home settings and at times when the child is still in the preschool age category. Through BPT, parents learn and are able to pay more attention to their children, give rewards and reinforcement for good behavior, and create a structure to instill discipline. To start, the following techniques might be helpful in establishing behavioral therapy in your household.
- Defining house rules — this allows you to give your child set limits as to his behavior around the house. It is always important to let the child know what happens if house rules are broken, as well as what happens when house rules are followed.
- Providing reward and reinforcement — To strengthen the good behavior of the child, it is always advisable to give the child immediate rewards so that the child knows what behavior to continue engaging in.
- Establishing routines — Although children with ADHD do not live by structure, it is important for you to create schedules so that they carry this routine into the future.
- Focusing on the positive — This helps the child build his confidence when he does the right things. Scolding the child for doing something wrong while completely ignoring the one thing he was able to do right will only demoralize the child. However, keep in mind that praising everything the child does will do nothing to boost his confidence as he knows that not everything he is doing is right.
As a child is increasingly integrated into his daily life in school, other behavioral therapies such as behavioral classroom management and behavioral peer interventions where teacher and peers are involved in the modification of the behavior of the child or adolescent. Ultimately, behavioral therapies allow the child to better adhere to parental commands, pay increased attention in class, as well as improved compliance with both house and classroom rules.
References
http://pediatrics.aappublications.org/content/pediatrics/early/2011/10/14/peds.2011-2654.full.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012746/
https://childrensmd.org/browse-by-age-group/why-do-stimulants-work-for-treatment-of-adhd/
https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html
https://www.everydayhealth.com/hs/adhd-and-your-child/adhd-behavior-management-strategies/
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