Attention-deficit/hyperactivity disorder (ADHD)
Optimal treatment for ADHD is a matter of intense debate. Current treatments typically involve therapy, medication or both.
Counseling therapies may include:
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Psychostimulants are the most commonly prescribed medications for treating ADHD in children. Sometimes doctors also prescribe antidepressants — especially for adults, and for children who don't respond to stimulants or who are depressed or have other problems.
Parents often wonder why stimulants are given to children who already seem overstimulated. Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of the brain chemicals dopamine, which is associated with activity, and serotonin, which is associated with a sense of well-being. Methylphenidate (Ritalin, Concerta), the primary medication used to treat ADHD, seems to increase levels of dopamine in the brain by blocking the activity of dopamine transporters, which remove dopamine after it has been released.
Psychostimulant medications may help alleviate the core symptoms of inattention and hyperactivity — sometimes dramatically. But these drugs don't address other problems, such as lack of academic achievement, poor social skills or conflict at home. In addition, some doctors question giving stimulants to young children, especially when no studies have been done to determine the long-term safety of these drugs.
The number of children treated with psychostimulants such as Ritalin has increased greatly in recent years. In fact, as many as 75 percent of children with ADHD may be taking some form of stimulant medication. Yet some studies have shown that without behavior therapy and educational services, medication alone isn't likely to be effective in improving a child's long-term outcome.
Besides methylphenidate, medications used to treat ADHD include d- and l-amphetamine racemic mixture (Adderall) and dextroamphetamine (Dexedrine). The most common side effects of psychostimulants include loss of appetite, nervousness and problems sleeping. Some children experience irritability or increased activity as the effect of the medication tapers off. Adjustments in doses can often offset these side effects.
A small percentage of children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Ritalin also may be associated with a slightly reduced growth rate in children. In most cases, however, growth isn't permanently affected. Ritalin or Concerta may also cause a loss of appetite, resulting in weight loss.
Parents also are understandably concerned about psychostimulants — which are similar to amphetamines — and the risk of addiction. But dependence hasn't been reported in children who take medications orally and at the proper dosage. That's because drug levels in the brain rise too slowly to produce a "high." On the other hand, reported abuse of ADHD medications by siblings and classmates of children and teenagers with ADHD is a growing problem.
In November 2002, the Food and Drug Administration approved a nonstimulant drug known as atomoxetine (Strattera) for treatment of ADHD. In tests, atomoxetine has proved almost as effective as methylphenidate but without its side effects and potential for abuse.
Behavior therapies and medications are the most thoroughly researched treatments for ADHD. Other approaches, such as biofeedback and neurobiofeedback are being studied but are still considered to be unproven and experimental.