What are the treatment options for ADHD?
The treatment will depend on how severe your child's condition is as well as the age of your child. Ideally, treatment should involve a team of professionals, experienced and trained in attention deficit hyperactivity disorder (ADHD).
Non-medicine treatments for ADHD
If your child has mild-to-moderate ADHD, the first step is usually for you and your child to be referred to a parent-training programme. Sometimes your child will also be referred to a group treatment programme aimed at improving behaviour. Family therapy may also be helpful. The parent programme may include such things as:
- Learning skills to manage and reduce problem behaviour.
- Learning more effective ways to communicate with your child.
- Helping you to understand your child's emotions and behaviours.
If your child has more severe ADHD, or when non-medicine treatments have not been helpful, medication is usually recommended.
Medicines for ADHD
The medicines used for ADHD have been used for many years and in many children, with good effect. Medicines are not usually given to children aged under 6 years. Treatment with medicines is provided under the supervision of a specialist in childhood behavioural disorders.
In the UK, either methylphenidate (Ritalin®) or atomoxetine is usually the initial medicine used for ADHD. Methylphenidate is the most commonly used medicine. Dexamfetamine or lisdexamfetamine is used for children who do not respond to these medicines. Guanfacine can also be used if the other medicines are not suitable or are not effective.
How does the methylphenidate work?
Methylphenidate works by increasing the amount of a brain chemical called dopamine in certain parts of the brain. The parts that it works on are responsible for self-control and attention. Increasing the amount of dopamine in these areas of the brain stimulates them to work better. This then helps to focus your child's attention and improve concentration. The most common side-effects to look out for with methylphenidate are difficulty with sleep (insomnia), loss of appetite and weight loss.
How quickly does methylphenidate work?
The short-acting methylphenidate begins working within about 20 minutes and lasts for 3-4 hours. The longer-acting version takes longer to start working but lasts for about 12 hours. It may take several weeks to see the full benefit of the medication.
How long will my child be on medication?
It is common to continue medication for several years. Once children become teenagers, it is recommended to trial off the medication each year. This is to make sure that medication is still necessary.
Are the medicines safe?
The use of medicines to treat ADHD is controversial. Guidelines from the National Institute for Health and Care Excellence (NICE) in the UK advise that they are still useful and important in the treatment of severe ADHD and in milder forms when other treatments have not been effective. The benefits of medicines usually outweigh any risks in children aged over 6 years with ADHD. The medicines do not seem to have an addictive potential when used in children.
What about diet in ADHD?
Diet probably does not cause ADHD, but a change in diet may help in some cases, although not in all cases. It may be that some children are badly affected by certain foods or additives.
Dietary changes for the treatment of ADHD have been widely used for many years. They take the form of:
- Supplements with substances thought to be lacking. For example, supplements of fatty acids such as omega 3 and omega 6; and/or
- Cutting out foods thought to be harmful. For example, cutting out foods containing artificial colouring and other additives.
A guideline on ADHD was published by NICE in 2008. The guideline found that there is no good evidence that dietary changes can help children with ADHD. However, NICE advised that if there was a clear link between eating specific foods and behaviour then the child should be referred to a dietician. Do not try a strict restrictive diet for your child by yourself. If you think that diet may be a factor, it is strongly advised that you ask your GP to refer you to a qualified dietician. A dietician can advise, and make sure that any limited diet contains the full range of nutrients that a growing child requires.
Do not try a strict restrictive diet for your child by yourself. It is recommended that all people with ADHD have a normal healthy balanced diet, and also do some regular exercise.
What else is available to help older children or adults with ADHD?
In older children, there may be some benefit from psychological treatments such as cognitive behavioural therapy (CBT) or social skills' training. These techniques aim to teach your child more about why they act and react the way that they do. They also give them strategies to use to help them to improve their behaviour and daily functioning.
In adults, medication is recommended as part of a treatment programme, which should also include psychological treatment, advice on behavioural management and assistance with education and employment.
Further reading and references
Attention deficit hyperactivity disorder: diagnosis and management; NICE Clinical Guideline (September 2008)
Management of attention deficit and hyperkinetic disorders in children and young people; Scottish Intercollegiate Guidelines Network - SIGN (October 2009)
Attention deficit hyperactivity disorder; NICE CKS, October 2015 (UK access only)
Post RE, Kurlansik SL; Diagnosis and management of adult attention-deficit/hyperactivity disorder. Am Fam Physician. 2012 May 185(9):890-6.
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