Attention-Deficit Hyperactivity Disorder - Treatment

Treatment

A combination of a psychostimulant, most commonly methylphenidate (Ritalin), and cognitive-behavioral therapy is proving to be the best option for treatment of children with ADHD. Although medication can be helpful during the initial years of treatment, some research indicates that the benefits of medication eventually wear off. It appears that ADHD symptoms may improve naturally over time, regardless of the treatment approach.

Signs that ADHD may be easing include not having to adjust medication dosages during growth spurts, no deterioration when a drug dose is missed, or new abilities to concentrate during “drug holidays.” (School vacation times are a good period to test the effectiveness of temporarily stopping medication.) The American Academy of Child and Adolescent Psychiatry suggests that parents evaluate whether medication can safely be withdrawn when children with ADHD have been free of symptoms for at least one year. If a child’s condition worsens after medication withdrawal, the drug should be resumed.

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Developing a Treatment Approach. The following guidelines may be useful in determining a treatment approach:

• Behavioral techniques should be tried first.
• If the symptoms are severe or do not respond, a trial using medication (usually psychostimulants), in combination with behavior modification therapy, is recommended.

Determining a Medication Regimen. Doctors still have a difficult time predicting which medications will produce beneficial results, so treatment is individualized and performed on a trial and error basis. In developing an effective medication plan, the following steps may be helpful:

• Before any drug is administered, a child should be given a thorough examination for any medical problems to be sure there are no medical conditions that interfere with the medication. It is especially important that children be checked for heart problems prior to initiating stimulant medication. (See “Risks of Stimulants” in the Medications section of this report.)
• Both the doctor and the parents should be very clear about the specific behaviors they hope the medication will target.
• The goal is to use the lowest possible dosage that produces improved behavior.
• If an initial regimen doesn't work, changing the dosage, or changing to a different medication often brings improvement.
• Frequent follow-up visits should be scheduled to assess the response and to detect possible side effects.