Attention deficit hyperactivity disorder (ADHD) is a problem related to brain development that causes inattention (inability to concentrate), hyperactivity (always being ‘on the go’) and impulsivity (lack of self-control).
There are 2 main types of treatment for ADHD: medicines and behavioural therapies. Ensuring parents and carers have a good understanding of their child’s condition is also important.
Medicines for ADHD
Medicines are not always needed in the treatment of ADHD, and are usually only used when symptoms are causing significant problems. Medicines are generally prescribed together with behavioural and educational treatment strategies.
Stimulants such as methylphenidate (Concerta, Ritalin) and dexamphetamine have been proven effective for improving the symptoms of ADHD, at least in the short term. Contrary to what you might expect, stimulants appear to balance levels of brain neurotransmitters (chemical messengers). This helps the symptoms because ADHD is related to problems with these neurotransmitters.
These medicines are usually short acting — they wear off after about 4–6 hours; however, long-acting formulations of methylphenidate lasting approximately 8 hours are now available. These are taken once a day (usually in the morning) and so don’t have to be taken at school.
If used as indicated, stimulants won’t make your child ‘high’ or become addicted; however, they can occasionally cause the following side effects.
- Reduced appetite — your doctor may recommend giving the tablets at or after breakfast or lunch if your child is affected.
- Headaches and abdominal discomfort — these may wear off with time.
- Sleep problems.
- Dizziness, tics or raised blood pressure — these side effects tend to be rare.
There have been concerns that stimulants may disrupt children’s growth. Recent studies suggest that any effect is small, and that weight is affected more than height, but your doctor will monitor your child’s growth if these medicines are used.
For children younger than 7 years, psychological, behavioural and family interventions should be tried before considering treatment with medicines. Stimulants are not usually used for children aged less than 4 years.
Children should be reviewed frequently by a doctor while they are on stimulants — to check for side effects and because it can take some time to get the dose right. If your child doesn’t respond to one stimulant, there is still a good chance he or she will respond to another.
Some doctors recommend children have a short break from stimulants at regular intervals, such as once a year, to see if the medicine is still needed. If you and your child try this approach, be aware that ADHD symptoms may flare up during the break. So it is best to schedule these times away from potentially stressful occasions like the start of a school year or exams. Some people take a break from medicines on weekends and during school holidays.
Atomoxetine (Strattera) is a medicine that acts on neurotransmitters but is not a stimulant. It is indicated for children aged 6 years or over, adolescents or adults with ADHD. Atomoxetine is available on the Pharmaceutical Benefits Scheme (PBS) providing it is prescribed by a paediatrician (a doctor specialising in children’s health) or psychiatrist, and where the patient meets a number of criteria.
Atomoxetine is an effective treatment of hyperactivity and inattention; however, it can cause side effects such as tiredness, constipation, dizziness, raised blood pressure, loss of appetite and upset stomach. There is some concern that, in rare cases, this medicine could increase the risk of thoughts of self-harm, lead to liver disease or have other side effects. Therefore, children taking atomoxetine should be monitored regularly by their doctor, and you should contact your doctor immediately if your child shows any of the following:
- sudden change or deterioration in mood or behaviour;
- thoughts or talk of self-harm, harm to others, or suicide;
- dark urine;
- yellow skin or eyes;
- pain in the upper right part of the abdomen; or
- unexplained flu-like symptoms.
There are several types of psychological therapy for ADHD.
Behavioural therapy aims to improve behaviour by focusing on changing the way children think and cope, to help them deal better with immediate issues. The therapist often helps the child organise homework or other tasks, and offers techniques to deal with stressful situations.
Cognitive behavioural therapy
Cognitive behavioural therapy aims to modify unwanted or unhelpful thoughts and to link this to changes in behaviour. It may be practised individually or in groups.
Social skills training
Social skills training helps a child develop better ways to cooperate with others. The therapist may explain and model appropriate behaviours such as waiting for a turn or sharing toys, and the child also learns how to respond to people suitably by ‘reading’ their tone of voice or facial expression.
Parenting skills training
Parenting skills training gives parents tools and techniques to help manage their child’s behaviour — they are shown how to use rewards to reinforce good behaviours and how to use mild penalties such as ‘time out’ to discourage undesired behaviours. Parents may also be taught how to structure situations to help their child, for example allowing only one or 2 playmates at a time so that their child does not become overstimulated. Ultimately the goal is to help children learn to control their own actions.
Family therapy aims to help family members understand and improve the way they interact. The whole family may be seen together or family members may attend individually. More research is needed into whether family therapy helps children with ADHD.
There is evidence that individually tailored school-based interventions can help improve classroom behaviour, academic performance and ADHD symptoms.
Diet and supplements and ADHD
So far, no consistent link has been shown between what a child eats and their ADHD symptoms. Although some parents find that a specific diet works for their child, it is always difficult to know whether the family started interacting differently when the diet was introduced and whether these behavioural changes were instead responsible for the improvement in symptoms.
Nevertheless, for general health, it is wise for children to eat a balanced diet containing a wide variety of nutritious foods. Be particularly wary of excluding whole food groups as this can potentially be harmful to your child’s development.
At present, there is not enough evidence that dietary supplements can reduce ADHD symptoms.
What’s best for my child?
Medicines are often needed if your child has severe ADHD symptoms. However, a combination of medicines and psychological therapy, as well as good support at school, can bring about the best results and reduce the dose of medicines required to control symptoms.
Every child needs an individual approach; your doctor or specialist will be able to advise you about the different treatments available for ADHD so that you can choose the best way forward for your child.
2. National Health and Medical Research Council (NHMRC). Health advice on attention deficit hyperactivity disorder (ADHD): Questions and answers (Sep 2012). http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/mh26a_adhd_cpp_qa_2012_120903.pdf (accessed Nov 2012).
3. National Institute of Mental Health. Attention deficit hyperactivity disorder (ADHD) (updated 2008). http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml (accessed Nov 2012).
4. American Academy of Pediatrics. ADHD: Clinical practice guideline for the diagnosis, evaluation and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011 Nov; 128(5): 1007-22. http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf+html (accessed Nov 2012).