Physician Resources

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Physicians

Introduction

Treatment for ADHD often involves a combination of approaches with the aim being to help the child in every aspect of life such as improve concentration at school and in homework, social interactions, family time, general happiness and well being. The information on this part of the site has been brought together from a variety of sources to provide tools and resources for physician in all aspects of ADHD management, to help ensure that the condition is treated for the benefit of the patient and those around them.

Attention Deficit Hyperactivity Disorder (ADHD) Treatment Options

ADHD is not restricted by geographical boundaries, and prevalence rates have been shown to be consistent world-wide.¹ What can vary greatly from country to country is the time and pathway to diagnosis, with some discrepancies linked to local attitudes towards mental illness. Diagnosis times have shown to range from 3 months to 5 years.² Two or three years can be a long time during a child’s formative development, when his/her self esteem and education may be compromised.

Diagnosis

When diagnosing ADHD, it is important to ensure that other possible causes for the child’s behavior are considered. There are no physical tests for ADHD with the commonest criteria being used to diagnose the condition being The American Psychiatric Association’s DSM-IV-TR.³

For more information see American Psychiatric Press: Diagnostic and statistical manual of mental disorders (DSM-IV).

The Importance of Multimodal Treatment

Research has shown that medication alone can improve ADHD symptoms, the current ADHD treatment practices focus on management of symptoms through a multimodal approach which may include:⁴

• Behavior modification (including coaching and therapy)
• Medications
• Combination therapy (medication and behavior therapy)

Treatment should be individualized for each patient.⁵

Treatment Process in Children and Adolescents with ADHD

The treatment process has three basic stages:

• Baseline evaluation: As part of the diagnostic evaluation, the physician or healthcare professional determines the target symptoms and the baseline degree of impairment
• Treatment strategy: The physician forms a treatment strategy by prioritizing the target symptoms and determining which treatment methods are best suited to reduce them
• Symptom monitoring and strategy adjustment: A key part of ADHD treatment is monitoring of symptoms in various areas (such as learning, academics, family interactions and peer relationships) and settings (such as home, school and extracurricular)

This multimodal approach has been found to improve achievement, help with social interaction and relieve pressure on the family.⁶

Behavioral Approaches

Behavioral interventions are an important part of a treatment plan for children who have ADHD.² Behavioral intervention strategies may include:

• Implementing consistency, by keeping to the same rules and daily timetable.⁷
• Using positive reinforcement, which can impact the child’s feeling of self-worth. Let the child know when they have done something well and when you are pleased with that child⁷.
• Teaching problem-solving, communication, and self-advocacy skills.⁸

Individual psychotherapy and cognitive therapy can benefit a child with ADHD to help them express their feelings, develop skills to cope with various situations and help the child to achieve an optimistic outlook and react to situations more positively.⁴

Family counseling sessions can assist the family to address any parenting or marital difficulties, while managing with the child’s ADHD symptoms and resulting behaviors.

Educational Approaches – School Programming and Supports

The academic and social impact for children with ADHD at school needs to be addressed, taking into account the child’s strengths and weaknesses, in order to develop an effective program.⁸

For children with ADHD, minor changes need to be made to their schooling environments. A number of behavioral interventions can be employed, together with classroom changes to help the child successfully cope.⁷

Special education services may be available to those children that require it, but this is dependent on country-specific educational provisions. These services may range from modifications in the classroom, to special placement outside the classroom to cope with the child’s individual educational requirements.⁸

It is important that parents collaborate with teachers to address the child’s needs while at school and to ensure support is provided.

Medication

Medication can play an important role in the management of ADHD symptoms.⁴ It can help a child be less restless, more able to concentrate and more likely to think before acting.⁴

There are different types of medication available to treat ADHD. All ADHD medications are thought to work by altering the levels of chemical neurotransmitters that pass messages between brain cells. Two of these chemicals are dopamine and norepinephrine. These two chemical neurotransmitters play an important role in behavior and cognition, helping with our ability to concentrate, to control our impulses and to behave normally.⁴ ADHD medications differ in their effects on these two chemical neurotransmitters.

One type of medication is thought to work by blocking the reuptake of norepinephrine in the brain.⁴ By blocking the reuptake of norepinephrinein the brain, it means there is more of this chemical available throughout the brain.

Another type of medication is thought to work by blocking the reuptake of both dopamine and norepinephrine. This type of medication can also cause the brain cells to release more of both chemicals.⁴ This means that there is more dopamine and norepinephrine available throughout the brain.⁴

The focus of ADHD treatment is the management of symptoms. Medication is typically the backbone of therapy. The most common types of medication used to treat ADHD are:^4,9

• Short-acting (4-5 hour)
• Intermediate-acting (6-8 hour)
• Long-acting (10-24 hour)

Although they are not officially approved for ADHD, antidepressants and antihypertensive (high blood pressure) medications are also sometimes used to treat the symptoms of ADHD.⁴

Informing the Parent about their Child’s Medication

When prescribing medication for ADHD, explain the dosage to the parents, together with the need to monitor their child’s ADHD symptoms.⁴ Possible side-effects of the medication need to be discussed, especially if there has been a change in dosage and it is important to explain to the parent that any side effects (those explained as possible side effects and any unexpected side effects) should be reported to the physician immediately.

References:

1. Faraone SV, Sergeant J et al., 2003. The Worldwide Prevalence of ADHD: Is it an American Condition? World Psych 2:104-113.
2. Without Boundaries, Challenges and Hopes for Living with ADHD: An International Survey 2005.
3. Barkley RA. 2003. Issues in the Diagnosis of Attention-Deficit/Hyperactivity Disorder in Children. Brain Dev 25:77-83.
4. Greydanus DE, Pratt HD and Patel DR. 2007. Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult. Dis Mon 53:70–131.
5. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. 2001. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 108:1033-44.
6. The MTA Cooperative Group. 1999. Moderators and Mediators of Treatment Response for Children with Attention-Deficit/ Disorder Hyperactivity Disorder. Arch Gen Psychiatry 56:1088-96.
7. Royal College of Psychiatrists. 2004. Good Parenting: Factsheet for Parents and Teachers.
8. US Department of Education. 2004. Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices.
9. CHADD National Resource Center on ADHD. Managing Medication for Children and Adolescents with AD/HD. www.help4adhd.org Accessed 4 July 2007