ADHD treatments

There are several treatments available in Australia that can help treat the symptoms of attention deficit hyperactivity disorder (ADHD). Treatment options include behaviour management strategies for parents and teachers, psychological therapy and medicines.

Many children with ADHD find that their symptoms - which can include inattention (inability to concentrate), hyperactivity (always being ‘on the go’) and impulsivity (lack of self-control) - improve as they get older. So, the need for ongoing treatment needs to be checked regularly with your child’s doctor or therapist.

Helpful strategies for managing a child with ADHD

The following tips can help children with ADHD and give parents a plan to help them manage. It’s a good idea to talk to your child’s teacher and share these strategies with them too.

  • Try to keep a regular schedule as much as you can. Structure can really help your child. Sudden changes in plans can be upsetting for kids with ADHD, so give them as much notice as possible if there is a change in routine.
  • Praise behaviours you want to encourage in your child and show them affection. Like all of us, children with ADHD respond to positive attention and this will help improve their confidence and self-esteem.
  • Be clear and consistent. When asking your child to do something, make sure you use eye contact, keep it simple and give one instruction at a time.
  • Try to remain as calm and patient as you can, as it should start to rub off on your child over time. If you need a break, take one when you can. Consider relaxation therapy or stress management for yourself to help you stay on track.

Remember, things won’t change overnight but if you persist with these strategies you should notice a difference over time.

Psychological therapies

There are several types of psychological therapy that can help children with ADHD. Your GP or paediatrician can refer you to a child psychologist or psychiatrist for psychological therapy.

Behavioural therapy

Behavioural therapy aims to improve behaviour by focusing on changing the way children think and cope, to help them deal better with immediate issues. Therapists can help children organise homework or other tasks, and offer 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 children 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 your 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. Parents 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

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.

Educational interventions

There is evidence that individually tailored school-based interventions can help improve classroom behaviour, academic performance and ADHD symptoms.

What medicines are used to treat 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.

Medicines for ADHD are usually prescribed by specialists - paediatricians, child psychiatrists or neurologists.

Stimulant medicines for ADHD

Stimulant medicines have been shown to help improve symptoms of inattention, impulsivity and hyperactivity for up to 3 years at least.

It’s not exactly known how stimulant medicines help in the treatment of ADHD, but it’s thought that they balance levels of neurotransmitters (chemical messengers) in the brain. This helps relieve symptoms because ADHD is related to problems with these neurotransmitters.

Stimulants include:

  • methylphenidate (brand names Artige, Concerta, Ritalin);
  • lisdexamfetamine (brand name Vyvanse); and
  • dexamfetamine.

Short-acting stimulants (which wear off after about 4 hours) include Artige, Concerta and Ritalin 10. Long-acting options (which last around 8-12 hours) include Concerta Extended-Release Tablets, Ritalin LA and Vyvanse. Long-acting stimulants are taken once a day (usually in the morning), so don’t have to be taken at school.

If used as indicated, stimulants won’t make your child ‘high’ or become addicted.

Side effects may include:

  • reduced appetite — your doctor may recommend giving the tablets at or after breakfast or lunch if your child is affected;
  • headaches;
  • tummy aches;
  • sleep problems such as insomnia;
  • dizziness; and
  • anxiety or irritability.

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.

Stimulant medicines may slightly raise blood pressure and heart rate, and may not be suitable for children with a history (or family history) of heart problems.

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 4-6 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.

Your doctor may recommend 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 breaks from stimulant medicines on weekends and during school holidays.

Other medicines for ADHD

Atomoxetine (examples of brand names include Strattera, Atomerra) is a medicine that acts on neurotransmitters but is not a stimulant.

Atomoxetine can treat symptoms of hyperactivity and inattention. It’s usually used in children who cannot take stimulant medicines or who have not improved on stimulants. It may also be a good option in children who also have anxiety or tics. It can take several weeks before you see any benefit from this medicine.

Atomoxetine can be prescribed for children aged 6 years or over, adolescents or adults with ADHD, and 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.

Side effects of atomoxetine can include tiredness, constipation, dizziness, mood swings, rash, insomnia, 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 or lead to liver disease. 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;
  • itching;
  • dark urine;
  • yellow skin or eyes;
  • pain in the upper right part of the abdomen; or
  • unexplained flu-like symptoms.

Guanfacine (brand name Intuniv) is a newer medicine that can be used to treat ADHD in children and teenagers (aged 6-17 years) when stimulants or atomoxetine are not suitable or effective. It can also be used together with stimulant medicines.

It’s not known exactly how guanfacine works in ADHD. This medicine is taken once daily.

Side effects can include headache, tiredness, abdominal pain, low blood pressure, reduced appetite, mood swings and sleep problems.

Can a special diet or supplements help treat 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.

For general health, it’s important 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 health and development.

At present, there is not enough evidence that dietary supplements can reduce ADHD symptoms.

What’s the best treatment option 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.

Your doctor will want to review your child regularly to assess their need for ongoing treatment.

Support

Support groups can help you connect with other families who have children with ADHD. This can provide not only emotional support, but also practical advice on dealing with children with ADHD and the effects it can have on the whole family. Ask your doctor or therapist, or search the internet for a support group.

References

1. Royal Children’s Hospital Melbourne. Attention deficit hyperactivity disorder (ADHD) (reviewed March 2018). https://www.rch.org.au/kidsinfo/fact_sheets/ADHD_Attention_deficit_hyperactivity_disorder/ (accessed Aug 2018).
2. Royal Children’s Hospital Melbourne. ADHD - ways to help children at school and home (updated March 2018) https://www.rch.org.au/kidsinfo/fact_sheets/ADHD_ways_to_help_children_at_school_and_home/
3. National Health and Medical Research Council (NHMRC). Clinical practice points on the diagnosis, assessment and management of attention deficit hyperactivity disorder in children and adolescents (published September 2012). http://www.nhmrc.gov.au/guidelines/publications/mh26 (accessed Aug 2018).
4. 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 Aug 2018).
5. National Institute of Mental Health. Attention deficit hyperactivity disorder (updated March 2016). https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml (accessed Aug 2018).
6. Tonge B. Principles for managing attention deficit hyperactivity disorder. Aust Prescr 2013;36:162-5. https://www.nps.org.au/australian-prescriber/articles/principles-for-managing-attention-deficit-hyperactivity-disorder (accessed Aug 2018).
7. Attention deficit hyperactivity disorder (published July 2013). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Aug 2018).
8. Guanfacine hydrochloride for attention deficit hyperactivity disorder. Aust Prescr 2018;41:131-2. https://www.nps.org.au/australian-prescriber/articles/guanfacine-hydrochloride-for-attention-deficit-hyperactivity-disorder (accessed Aug 2018).
9. Lisdexamfetamine for ADHD. Aust Prescr 2013;36:212-8. https://www.nps.org.au/australian-prescriber/articles/lisdexamfetamine (accessed Aug 2018).
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