By Dr Ananya Mandal, MD
There is no cure for Attention Deficit Hyperactivity Disorder (ADHD). Therapy aims to reduce the symptoms to allow for normal learning and growth of the child.
Basic tenets of therapy include medication and counselling. Other parts of therapy include accommodating the child in regular classrooms and providing family and community support.
Types of ADHD Medication –
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Medications used for ADHD are known as psychostimulants and nonstimulants like Atomoxetine. These come in oral forms like tablets, capsules, liquids and also in form of skin patches.
Stimulants include Methylphenidate (Brand names Ritalin, Concerta, Daytrana), Dextroamphetamine-amphetamine (Adderall) and Dextroamphetamine (Dexedrine, Dextrostat).
These stimulants improve the deranged balance of nerve messengers in the brain called neurotransmitters. They help to improve the major symptoms of hyperactivity-impulsivity and inattention.
Length of action of ADHD medication
ADHD medication may be short acting, where action lasts for around four hours, or long acting where action lasts between six and twelve hours.
Methylphenidate for example can be given as a patch that when applied over the hip much like a bandaid can deliver the medication into the body over nine hours.
Long acting preparations usually take time to begin their action but carry the advantage of less frequent dosing.
These stimulants however tend to lose their efficacy over time. In addition all children do not benefit at similar doses and the right dosing sometimes may take time.
Side effects of ADHD medication
Common side effects include weight loss and loss of appetite, sleep disturbances, irritability towards the end of action of the medication etc.
Some children may develop twitches or jerky movements as side effects and in some growth may be affected.
These side effects are not permanent and may be reversed after the drug is stopped.
There are some reports of sudden death in children and adolescents using psychostimulants. This risk is raised in those with underlying heart disease or heart defect.
Furthermore, Methylphenidate and Dexamphetamine cannot be taken by pregnant women, children or persons with glaucoma, hyperthyroidism (overactive thyroid) and severe depression.
Nonstimulant ADHD medication
Nonstimulant medication for ADHD includes Atomoxetine. It is chosen when stimulant drugs are ineffective or cause side effects.
This drug needs to be taken once or twice daily and also reduces anxiety.
Side effects include loss of appetite and weight, nausea and sleepiness. Rare side effects include liver problems, depression and suicidal thoughts.
Children who do not respond to these medications are prescribed other drugs. These include antidepressants and Clonidine (actually a high blood pressure medication).
All medications used in ADHD should be kept out of the child’s reach and administered only under adult supervision.
Behavioural therapy and counselling for ADHD –
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Apart from medications, children with ADHD often benefit from counselling and behavioural therapy.
This may be imparted by a trained psychologist, psychiatrist, mental health care professional or social worker. These include –
- Behavioural therapy – In this the parents and caregivers are taught strategies to deal with difficult situations. These may include reward systems and timeouts.
- Parental, family and sibling training – Parents may be taught better parental skills to bring out the best behaviour in the child and also help cope with behavioural problems. Similarly the whole family may be taught how to support the child with ADHD in a positive manner. Major family and parental skill includes patience, lover and care for the child, keeping things in perspective, appreciation, organization, regularity of schedules and avoidance of major changes. The child should be well rested and difficult situations should be anticipated beforehand. Instructions given to the child need to be simply worded and easy to follow.
- Psychotherapy is beneficial for older children. Negative behaviours may be reduced by this method.
- Social skills training – Children with ADHD can be taught various social skills to help them adapt better to the community.
- Discovering a talent – This helps the child feel good about themselves and often improves self-esteem and symptoms of ADHD.
Behavioural therapy is team effort and needs to be coordinated.
Other therapies for ADHD
Other alternative calming therapies include yoga and meditation.
There is no solid evidence that certain foods if banished from diet or added (like vitamin supplements, herbal medications, essential fatty acids etc.) help in reducing symptoms of ADHD. However ADHD children need to be given a healthy balanced diet. It is advisable not to remove anything from the child’s diet without medical advice.
Regular exercise is also recommended in persons with ADHD. Over years the symptoms of ADHD lessen considerably but may never completely go away.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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