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Treatments and drugs
By Mayo Clinic staffStandard treatments for ADHD in children include medications and counseling. Other treatments to ease the effects of ADHD symptoms include special accommodations in the classroom, and family and community support.
Medications
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.
Stimulant medications for ADHD include:
- Methylphenidate (Ritalin, Concerta, Daytrana)
- Dextroamphetamine-amphetamine (Adderall)
- Dextroamphetamine (Dexedrine, Dextrostat)
Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These ADHD medications help improve the core signs and symptoms of inattention, impulsivity and hyperactivity — sometimes dramatically. However, these medications only work for a limited time. Additionally, the right dose varies from child to child, so it may take some time in the beginning to find the correct dose.
Stimulant drugs are available in short-acting and long-acting forms.
- The short-acting forms last about four hours, while the long-acting preparations usually last between six and 12 hours.
- Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean your child won't need to take medication as often, it can take up to three hours to start working. For it to work in the morning, the patch may need to be put in place early while your child is still asleep.
Stimulant medication side effects
The most common side effects of stimulant medications in children include:
- Decreased appetite
- Weight loss
- Problems sleeping
- Irritability as the effect of the medication tapers off
A few children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.
ADHD medications and heart problems
Although rare, several heart-related deaths occurred in children and adolescents taking stimulant medications. The increased risk of sudden death is believed to be in people who already have underlying heart disease or a heart defect. Your child's doctor will make sure your child doesn't have any signs of a heart condition, and will ask about family risk factors for heart disease before prescribing a stimulant medication.
Nonstimulant medication
Atomoxetine is generally given to children with ADHD when stimulant medications aren't effective or cause side effects. In addition to reducing ADHD symptoms, atomoxetine may also reduce anxiety. Given one or two times a day, atomoxetine side effects can include nausea and sedation. It can also cause reduced appetite and weight loss.
Nonstimulant medication side effects
Atomoxetine has been linked to rare side effects that include liver problems. If your child is taking atomoxetine and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact the doctor right away.
There may also be a slightly increased risk of suicidal thinking in children and adolescents taking atomoxetine. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.
Other medications used to treat ADHD include:
- Antidepressants. These medications are generally used in children who don't respond to stimulants or atomoxetine, or who have a mood disorder as well as ADHD.
- Clonidine (Catapres) and guanfacine (Intuniv, Tenex). These are high blood pressure medications shown to help with ADHD symptoms. They may be prescribed to reduce tics or insomnia caused by other ADHD medications, or to treat aggression caused by ADHD.
Giving medications safely
Making sure your child takes the right amount of the prescribed medication is very important. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn't been shown in children who take these drugs for appropriate reasons and at the proper dose. That's because medication levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse stimulant medications. To keep your child's medications safe and to make sure your child is getting the right dose of medication at the right time:
- Administer medications carefully. Children and teens shouldn't be in charge of their own ADHD medication.
- At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal.
- Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
ADHD counseling and therapy
Children with ADHD often benefit from behavior therapy or counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling types include:
- Behavior therapy. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations. These strategies may include token reward systems and timeouts.
- Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
- Parenting skills training. This can help parents develop ways to understand and guide their child's behavior
- Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
- Social skills training. This can help children learn appropriate social behaviors.
- Support groups. Support groups can offer children with ADHD and their parents a network of social support, information and education.
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.
Symptoms often lessen with age. However, most people never completely outgrow their ADHD symptoms.
- Attention deficit/hyperactivity disorder. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/adhd_booklet.pdf. Accessed Nov. 10, 2010.
- Attention-deficit/hyperactivity disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Nov. 10, 2010.
- Rucklidge JJ. Gender differences in attention/deficit hyperactivity disorder. Psychiatric Clinics of North America. 2010;33:357.
- Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Elk Grove Village, Ill. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement, et al. Pediatrics. 2001;108:1033.
- Rader R, et al. Current strategies in the diagnosis and treatment of childhood attention-deficit/hyperactivity disorder. American Family Physician. 2009;79:657.
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- Wilms Floet AM, et al. Attention-deficit/hyperactivity disorder. Pediatrics in Review. 2010;31:56.
- Krisanaprakornkit T, et al. Meditation therapies for attention-deficit/hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews. 2010:CD006507. http://www.cochrane.org/reviews. Accessed Nov. 10, 2010.
- Larzelere MM, et al. Complementary and alternative medicine usage for behavioral health indications. Primary Care Clinics. 2010;37:213.
- Swintak CC (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 19, 2010.
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