Drug to treat adhd. Comprehensive Guide to ADHD Medications: Treatments, Side Effects, and Comparisons
What are the main types of ADHD medications. How do stimulants and non-stimulants differ in treating ADHD. What are the potential side effects of ADHD medications. How to choose the right ADHD medication for individual needs. What precautions should be taken when using ADHD medications.
Understanding ADHD Medication Options: Stimulants vs. Non-Stimulants
Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition that affects millions worldwide. Medication plays a crucial role in managing ADHD symptoms, but navigating the various treatment options can be overwhelming. This comprehensive guide delves into the different types of ADHD medications, their effectiveness, and potential side effects to help you make informed decisions about treatment.
The two main categories of ADHD medications are stimulants and non-stimulants. Each type has its unique characteristics and benefits:
- Stimulants: These are the most commonly prescribed ADHD medications, known for their quick action and high efficacy.
- Non-stimulants: These medications offer an alternative for those who don’t respond well to stimulants or experience adverse side effects.
Are stimulants always the first choice for ADHD treatment. While stimulants are often considered the first-line treatment due to their effectiveness in 70-80% of cases, they may not be suitable for everyone. Factors such as individual response, medical history, and potential side effects influence the choice between stimulants and non-stimulants.
Stimulant Medications for ADHD: Types, Benefits, and Considerations
Stimulant medications have been used to treat ADHD for several decades. They work by increasing the levels of certain neurotransmitters in the brain, which helps improve focus and reduce impulsivity. Stimulants are available in two main types:
- Short-acting stimulants
- Intermediate and long-acting stimulants
Can stimulants effectively manage ADHD symptoms in both children and adults. Yes, stimulants have shown significant efficacy in treating ADHD across age groups. They can help improve concentration, reduce hyperactivity, and enhance overall functioning in school, work, and social settings.
Short-Acting Stimulants
Short-acting stimulants provide quick relief of ADHD symptoms but require more frequent dosing throughout the day. Common short-acting stimulants include:
- Methylphenidate (Ritalin)
- Dextroamphetamine (Dexedrine)
- Amphetamine/dextroamphetamine combination (Adderall)
Do short-acting stimulants have any advantages over long-acting formulations. Short-acting stimulants offer more flexible dosing and may be preferred for individuals who need coverage for specific times of the day or those who experience side effects with longer-acting medications.
Intermediate and Long-Acting Stimulants
These formulations provide extended symptom relief, often lasting throughout the school or workday with a single dose. Examples include:
- Methylphenidate extended-release (Concerta, Ritalin LA)
- Amphetamine extended-release (Adderall XR, Vyvanse)
- Dexmethylphenidate extended-release (Focalin XR)
How do long-acting stimulants benefit ADHD patients. Long-acting stimulants offer consistent symptom control throughout the day, reducing the need for multiple doses and potentially improving medication adherence. This can be particularly beneficial for school-aged children and working adults who require sustained focus.
Non-Stimulant ADHD Medications: Alternatives and Their Efficacy
Non-stimulant medications provide an alternative treatment option for individuals who don’t respond well to stimulants or experience intolerable side effects. These medications work differently from stimulants and may take longer to show full effects. Common non-stimulant ADHD medications include:
- Atomoxetine (Strattera)
- Guanfacine (Intuniv, Tenex)
- Clonidine (Kapvay, Catapres)
- Viloxazine (Qelbree)
Why might a doctor prescribe non-stimulant medications for ADHD. Non-stimulants may be recommended for patients with a history of substance abuse, those who experience severe side effects from stimulants, or individuals with certain cardiovascular conditions that preclude stimulant use. Additionally, some patients may prefer non-stimulant options due to personal preferences or concerns about stimulant medications.
Antidepressants in ADHD Treatment: Addressing Comorbid Conditions
Many individuals with ADHD also experience co-occurring mental health conditions such as depression, anxiety, or bipolar disorder. In these cases, antidepressants may be prescribed alongside ADHD medications to address multiple symptoms. Common antidepressants used in ADHD treatment include:
- Bupropion (Wellbutrin)
- Venlafaxine (Effexor)
- Desipramine (Norpramin)
How do antidepressants complement ADHD treatment. Antidepressants can help manage mood disorders and anxiety that often accompany ADHD, leading to improved overall functioning and quality of life. They may also have some direct benefits on ADHD symptoms, particularly in terms of improving focus and reducing impulsivity.
Side Effects and Safety Considerations of ADHD Medications
While ADHD medications can be highly effective, they may also come with potential side effects. It’s crucial to understand these risks and work closely with healthcare providers to monitor and manage any adverse effects. Common side effects of ADHD medications include:
- Loss of appetite and weight loss
- Sleep problems
- Mood changes (irritability, anxiety)
- Increased heart rate and blood pressure
- Tics or worsening of existing tics
What are the long-term effects of using ADHD medications. While many individuals use ADHD medications safely for extended periods, concerns exist about potential long-term effects. These may include growth suppression in children, cardiovascular risks, and the potential for substance abuse with stimulant medications. Ongoing research continues to evaluate the long-term safety profiles of ADHD medications.
FDA Warnings and Safety Advisories
The U.S. Food and Drug Administration (FDA) has issued several warnings and safety advisories regarding ADHD medications:
- Risk of drug abuse with amphetamine stimulants
- Potential for heart and psychiatric problems with stimulant medications
- Increased risk of suicidal thoughts in teens taking certain non-stimulant medications, particularly atomoxetine (Strattera)
How can patients and caregivers mitigate the risks associated with ADHD medications. Regular monitoring, open communication with healthcare providers, and adherence to prescribed dosages are essential for minimizing risks. Patients should report any unusual symptoms or side effects promptly and undergo periodic health assessments to ensure the ongoing safety and efficacy of their treatment.
Choosing the Right ADHD Medication: Factors to Consider
Selecting the most appropriate ADHD medication is a personalized process that involves careful consideration of various factors. Healthcare providers work closely with patients and their families to determine the best treatment approach. Key considerations include:
- Severity and type of ADHD symptoms
- Age of the patient
- Presence of co-occurring conditions
- Individual response to medications
- Potential side effects and tolerability
- Lifestyle factors and daily routine
Is it common to try multiple medications before finding the right fit. Yes, finding the optimal ADHD medication and dosage often requires a trial-and-error process. Patients may need to try different medications or combinations to achieve the best symptom control with minimal side effects. This process requires patience and close collaboration with healthcare providers.
Multimodal Treatment Approaches: Combining Medication with Other Therapies
While medication is a crucial component of ADHD treatment, a comprehensive approach often yields the best results. Multimodal treatment combines medication with other therapeutic interventions to address various aspects of ADHD and improve overall functioning. Components of a multimodal treatment plan may include:
- Behavioral therapy
- Cognitive-behavioral therapy (CBT)
- Parent training and education
- Social skills training
- Educational interventions and accommodations
- Lifestyle modifications (diet, exercise, sleep hygiene)
How does combining medication with other therapies enhance ADHD treatment outcomes. A multimodal approach addresses ADHD symptoms from multiple angles, potentially leading to better symptom management, improved coping skills, and enhanced quality of life. This comprehensive strategy can help individuals develop long-term strategies for managing ADHD beyond medication alone.
Monitoring and Adjusting ADHD Medication Treatment
Effective ADHD treatment requires ongoing monitoring and periodic adjustments to ensure optimal symptom control and minimize side effects. Regular follow-up appointments with healthcare providers are essential for assessing treatment progress and making necessary modifications. Key aspects of monitoring ADHD medication treatment include:
- Evaluating symptom improvement
- Assessing side effects and tolerability
- Monitoring growth and development in children
- Checking vital signs (blood pressure, heart rate)
- Adjusting dosages as needed
- Considering changes in medication type or formulation
How often should ADHD medication treatment be reviewed. The frequency of medication reviews may vary depending on individual needs and treatment response. Initially, more frequent check-ins (every few weeks to months) may be necessary. Once a stable and effective regimen is established, reviews may occur less frequently, typically every 3-6 months or as recommended by the healthcare provider.
The Role of Patient and Caregiver Feedback
Patient and caregiver input is invaluable in the ongoing management of ADHD medication treatment. Keeping a symptom diary, noting any side effects, and communicating openly with healthcare providers can help inform treatment decisions and ensure the best possible outcomes.
What information should patients and caregivers track to support medication management. Important details to monitor and report include changes in ADHD symptoms, side effects experienced, impact on daily functioning, sleep patterns, appetite, and mood. This information helps healthcare providers make informed decisions about medication adjustments and overall treatment strategies.
ADHD Medication in Special Populations: Children, Adults, and Elderly
ADHD affects individuals across the lifespan, and medication treatment may need to be tailored to specific age groups and life stages. Special considerations apply when treating ADHD in children, adults, and elderly patients:
Children and Adolescents
ADHD medication use in children requires careful consideration of factors such as:
- Age-appropriate dosing
- Potential impact on growth and development
- School performance and social functioning
- Parental involvement in medication management
Are there any age restrictions for ADHD medications in children. Most stimulant medications are approved for use in children aged 6 and older, while some non-stimulants are approved for children as young as 3. However, the decision to start medication in young children should be made carefully, considering the severity of symptoms and potential risks and benefits.
Adults with ADHD
Adult ADHD treatment may involve considerations such as:
- Impact on work performance and relationships
- Interactions with other medications
- Management of co-occurring conditions
- Substance abuse history and risk
Can adults be newly diagnosed with ADHD and start medication treatment. Yes, many adults receive ADHD diagnoses later in life and can benefit from medication treatment. A thorough evaluation by a healthcare professional experienced in adult ADHD is crucial for accurate diagnosis and appropriate treatment planning.
Elderly Patients with ADHD
ADHD treatment in older adults may require special attention to:
- Cardiovascular health and medication interactions
- Cognitive changes associated with aging
- Potential impact on other age-related conditions
- Dosage adjustments based on metabolism changes
How does ADHD medication treatment differ for elderly patients. Elderly patients may require more cautious dosing and closer monitoring due to age-related changes in metabolism and increased risk of medication interactions. Non-stimulant options may be preferred in some cases to minimize cardiovascular risks.
Future Directions in ADHD Medication Research and Development
The field of ADHD treatment continues to evolve, with ongoing research aimed at developing new medications and improving existing ones. Some areas of focus in ADHD medication research include:
- Novel drug targets and mechanisms of action
- Personalized medicine approaches based on genetic profiles
- Long-acting formulations with improved side effect profiles
- Non-pharmacological interventions to complement medication treatment
- Technologies to enhance medication adherence and monitoring
What promising developments are on the horizon for ADHD treatment. Emerging research is exploring the potential of precision medicine in ADHD, aiming to match patients with the most effective treatments based on their genetic makeup and biomarkers. Additionally, novel drug delivery systems and formulations are being developed to provide more consistent symptom control with fewer side effects.
The Role of Digital Health in ADHD Management
Digital health technologies are increasingly being integrated into ADHD treatment strategies. These may include:
- Mobile apps for symptom tracking and medication reminders
- Telemedicine platforms for remote consultations and monitoring
- Digital cognitive training programs to complement medication treatment
- Wearable devices for real-time monitoring of physiological parameters
How can digital health tools enhance ADHD medication management. Digital health technologies can improve medication adherence, facilitate more frequent communication between patients and healthcare providers, and provide valuable data for treatment optimization. These tools may also help in early detection of side effects and enable timely interventions.
In conclusion, ADHD medication treatment offers significant benefits for many individuals struggling with attention and hyperactivity issues. However, it requires careful consideration of various factors, ongoing monitoring, and a personalized approach to achieve optimal results. By understanding the different medication options, potential side effects, and the importance of comprehensive care, individuals with ADHD and their caregivers can work effectively with healthcare providers to develop tailored treatment plans that improve quality of life and overall functioning.
Compare ADHD Drug Treatments & Side Effects
Written by WebMD Editorial Contributors
- ARTICLES ON ADHD MEDICATIONS SIDE EFFECTS
- Types of Short-Acting Stimulants and Side Effects
- Types of Intermediate and Long-Acting Stimulants and Side Effects
- Types of Non-Stimulant ADHD Medications and Side Effects
- Types of Antidepressant ADHD Medications and Side Effects
- ADHD Medicines and Safety
- Treatment for ADHD and Other Conditions
- More
- ADHD Medication Chart
- Long-Term Effects of Stimulants
- ADHD Stimulants and Your Weight
- ADHD and Exercise
Medication is an important part of your ADHD treatment. Doctors can choose from many types of drugs to control symptoms of the disorder.
You and your doctor will work together to figure out which medication is right for you, along with the ideal dose (amount) and schedule (how often or when you need to take it). It may take some time to find the best combination.
Medications may not work for all ADHD symptoms or affect everyone the same way. A combination of medication, therapy, behavior changes, and skills training is often the most effective treatment. This is called multimodal treatment.
The ones most widely used to treat ADHD include:
- Stimulants. This group of drugs has treated ADHD for several decades. These medicines might help you focus your thoughts and ignore distractions. Stimulant meds work for 70% to 80% of people. They’re used to treat moderate and severe ADHD. They may be helpful for children, teens, and adults who have a hard time at school, work, or home. Some stimulants are approved for use in children over age 3. Others are approved for children over age 6.
- Non-stimulants. In cases where stimulants don’t work or cause unpleasant side effects, non-stimulants might help. These medications can improve symptoms like concentration and impulse control.
- Antidepressants. People with ADHD often have depression, anxiety, and bipolar disorder too. They may take an antidepressant to control mental health issues or other conditions along with a stimulant for ADHD.
Side effects of short-acting stimulants include loss of appetite, weight loss, sleep problems, crankiness, and tics. You have to take them often.
The FDA has issued a warning about the risk of drug abuse with amphetamine stimulants. FDA safety advisers are also concerned that all amphetamine and methylphenidate stimulants used for ADHD may make heart and psychiatric problems more likely.
Side effects of these medications include loss of appetite, weight loss, sleep problems, crankiness, and tics. Long-acting medicines may have greater effects on appetite and sleep. The FDA warns about the risk of drug abuse with amphetamine stimulants. FDA safety advisers are also concerned that all amphetamine and methylphenidate stimulants used for ADHD may make heart and psychiatric problems more likely.
Non-stimulant medications usually take a while to start working. It could be several weeks before you feel the full effects. Also, they may not work as well as stimulants. Some non-stimulant medications may raise the risk of suicidal thoughts and death by suicide in teens. The FDA warns that anyone taking atomoxetine (Strattera) should be monitored for suicidal thoughts, especially during the first few weeks. Common side effects of these drugs include fatigue, upset stomach, dry mouth, and nausea. Your blood pressure often rises when you stop taking them.
Drug Name | Brand Name | Duration | Notes |
Atomoxetine | Strattera | 24 hours | Sleep problems, anxiety, fatigue, upset stomach, dizziness, dry mouth. Although rare, can cause liver damage. Higher risk of suicide in adults ages 18-24. |
Clonidine | Catapres | 4-6 hours | Fatigue, dizziness, dry mouth, crankiness, behavior problems, low blood pressure. Stopping this medicine suddenly can result in high blood pressure. |
Clonidine | Catapres-TTS patch | Up to 7 days | Fatigue, dizziness, dry mouth, crankiness, behavior problems, low blood pressure. Stopping this medicine suddenly can result in high blood pressure. |
Clonidine | Kapvay | 12 hours | Fatigue, dizziness, dry mouth, crankiness, behavior problems, low blood pressure. Stopping this medicine suddenly can result in high blood pressure. |
Guanfacine | Intuniv | 24 hours | Fatigue, dizziness, dry mouth, crankiness, behavior problems, low blood pressure. Stopping this medicine suddenly can result in high blood pressure. |
Guanfacine | Tenex | 6-8 hours | Fatigue, dizziness, dry mouth, crankiness, behavior problems, low blood pressure. Stopping this medicine suddenly can result in high blood pressure. |
Viloxazine | Qelbree | 12 Hours | Tiredness, sleepiness, nausea, vomiting, sleeplessness, irritability, decreased appetite |
These medications can be used off-label to treat ADHD symptoms. That means doctors can prescribe them even though they haven’t been approved by the FDA for use with ADHD, Side effects often include trouble sleeping, nausea, constipation, dry mouth, sweating, and changes in sex drive. The FDA has also warned about a connection between antidepressants and a higher risk of suicide in adults ages 18-24, especially in the first 1 or 2 months.
Drug Name | Brand Name | Duration | Notes |
Bupropion | Wellbutrin | 4-5 hours | Headaches. Although rare, may make you more likely to have seizures. |
Bupropion | Wellbutrin SR | 12 hours | Headaches. Although rare, may make you more likely to have seizures. |
Bupropion | Wellbutrin XL | 24 hours | Headaches. Although rare, may make you more likely to have seizures. |
Desipramine | Norpramin | 8-24 hours | Not recommended for children. Associated with rare cases of fatal heart problems. |
Imipramine | Tofranil | 8-24 hours | Anxiety, fatigue, upset stomach, dizziness, dry mouth, higher heart rate, risk of heart arrhythmias. |
Nortriptyline | Aventyl, Pamelor | 8-24 hours | Anxiety, fatigue, upset stomach, dizziness, dry mouth, higher heart rate, risk of heart arrhythmias. |
Experts generally consider these medicines safe when they are monitored properly by a professional. Serious problems are rare. Discuss the risks and benefits of these drugs with your doctor.
Up to 80% of people with ADHD also have another mental health condition such as anxiety, depression, personality disorders, and substance use disorders. These issues and their treatment can affect ADHD, and vice versa. For example, some stimulant medications can make anxiety symptoms worse. But your doctor can often safely combine treatments for depression and ADHD. Your treatment plan will depend on your overall mental health.
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The 15 Best Exercises to Manage ADHD Symptoms
Written by Rachel Reiff Ellis
- Does Exercise Help ADHD?
- Types of Exercise You Can Do
- How to Keep at It
You may have heard that regular exercise can give your mood a boost. If you have ADHD, a workout does more than make you feel good. It can help control your symptoms, too.
Even a single session of moving your body can make you more motivated for mental tasks, increase your brainpower, give you energy, and help you feel less confused. It acts on your brain in a lot of the same ways as your ADHD medication.
To reap these rewards, though, you need to exercise the right way and the right amount. The key is to find an activity that fits your lifestyle and then stick with it.
Exercise isn’t just good for shedding fat and toning muscles. It can help keep the brain in better shape, too. When you exercise, your brain releases chemicals called neurotransmitters, including dopamine, which help with attention and clear thinking. People with ADHD often have less dopamine than usual in their brain.
Fitness can have the following benefits for adults with ADHD:
- Ease stress and anxiety.
- Improve impulse control and reduce compulsive behavior.
- Enhance working memory.
- Improve executive function. That’s the set of skills needed to plan, organize, and remember details.
- Increase levels of brain-derived neurotrophic factor. That’s a protein involved in learning and memory. It’s in short supply in people with ADHD.
The effects of exercise only last for so long, just like medicine. Think of your workout as a treatment “dose.” Aim for at least one 30- to 40-minute activity a day, 4 or 5 days a week.
The exercise you choose is up to you, but make sure it’s “moderately intense,” which means that during your workout:
- Your heart rate goes up
- You breathe harder and faster
- You sweat
- Your muscles feel tired
Talk to your doctor if you’re unsure how intense your exercise should be. They may recommend you use a heart rate monitor or some other device to make sure you get the most out of your workout.
1800x1200_treadmill_exercise_minibead
Exercise can help control your ADHD symptoms. Photo credit: Nd3000/Dreamstime
Aerobic exercise. This is anything that gets your heart pounding. You want to do something that raises your heart rate and keeps it there for a set amount of time, like half an hour to 40 minutes.
Aerobic exercise creates new pathways in your brain and floods it with the chemicals that help you pay attention.
You can try one of these:
- Running
- Walking briskly
- Biking
- Swimming laps
You can do these activities outdoors or indoors, but if you have a choice, go outside. Studies show that being in nature while you move can reduce your ADHD symptoms even more than when you exercise inside.
Martial arts. Experts say the more complex your exercise is, the better for your brain. Sports like karate, taekwondo, jiujitsu, and judo focus on self-control and bringing together your mind and body.
When you do martial arts, you get training in skills like:
- Focus and concentration
- Balance
- Timing
- Memory
- Consequences of actions
- Fine motor skills
Other complex exercises. If martial arts isn’t your thing, other physical activities that challenge your mind and body are:
- Rock climbing
- Dance
- Gymnastics
- Yoga
Strength training. If you’re only just starting out with exercise, go for aerobic activities like walking or jogging at first. After you’ve been at it for a while, add in some strength work for variety. Try exercises like:
- Lunges
- Squats
- Pushups
- Pullups
- Weightlifting
Team sports. If you join a softball or soccer league, it may be just the thing to get you up and moving several times a week. Organized sports have all the benefits of physical exercise with the added bonus of a social group to motivate you.
Teamwork hones your communication skills and helps you think through your actions and plan ahead. Being part of a team can also improve your self-esteem.
Just like medicine, exercise only helps you treat ADHD if you keep it up. But if you have problems with your attention span, how do you stay the course? Try these tips:
Keep it interesting. Switch up the type of exercise. You can stay out of a rut if you change your activity every day or week.
Find a partner. A workout buddy can help you stay on track and help pass the time while you sweat.
Move in the morning. If it fits in your schedule, exercise first thing in the morning before you take your medication. That way, you’ll get the most benefit from all the extra mood-boosting chemicals in your body.
Maintain meds. Exercise can give you a huge leg up on your ADHD symptoms, but it doesn’t replace your medication. Don’t stop your other treatments unless your doctor says it’s OK.
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Is methylphenidate an effective treatment for children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and does it cause unwanted effects?
Basic provisions
– Methylphenidate may reduce hyperactivity and impulsivity and help children concentrate. Methylphenidate may also help improve the overall behavior and quality of life of children with ADHD.
Methylphenidate does not appear to increase the risk of serious (life-threatening) adverse effects when used for up to six months. However, it is associated with an increased risk of non-serious adverse effects such as sleep problems and decreased appetite.
– Future studies should be more focused on reporting adverse effects and should be conducted over longer periods of time.
What is Attention Deficit Hyperactivity Disorder (ADHD)?
ADHD is one of the most commonly diagnosed and treated childhood psychiatric disorders. Children with ADHD have difficulty concentrating. They are often hyperactive (fidgety, unable to sit still for long periods of time) and impulsive (do things without stopping to think). ADHD can make it difficult for children to do well in school because they have difficulty following instructions and concentrating. Their behavioral problems can prevent them from getting along well with family and friends, and they often get into more trouble than other children.
How is ADHD treated?
Methylphenidate (eg Ritalin) is the most commonly prescribed drug for children and adolescents with ADHD. Methylphenidate is a stimulant that helps increase the activity of certain areas of the brain, such as those associated with concentration. Methylphenidate can be taken as a tablet or applied to the skin as a patch. Its dosage form can be formulated to act immediately or act slowly over several hours. Methylphenidate may cause unwanted effects such as headaches, stomach pain, and sleep problems. Sometimes it causes serious unwanted effects such as heart problems, hallucinations, or “tics” (twitches) of the face.
What did we want to find out?
We wanted to find out whether methylphenidate improves children’s ADHD symptoms (attention, hyperactivity), based primarily on teachers’ ratings on various scales, and whether it causes serious adverse effects such as death, hospitalization, or disability. We were also interested in less serious adverse effects such as sleep problems and loss of appetite, as well as its impact on children’s overall behavior and quality of life.
What have we done?
We searched for studies investigating the use of methylphenidate in children and adolescents with ADHD. Study participants had to be 18 years of age or younger and have a diagnosis of ADHD. They may have had other disorders or diseases, they may have taken other medications, or they may have received behavioral therapy. They were supposed to have a normal IQ (intelligence quotient). Most of the trials compared methylphenidate to a placebo, a pacifier that looks and tastes like methylphenidate but does not contain the active ingredient. Participants were to be randomly selected to receive or not receive methylphenidate. We compared and summarized the results of these studies, and assessed our confidence in the evidence, based on factors such as study methods and study size.
What did we find?
We found 212 studies involving 16,302 children or adolescents with ADHD. Most studies have compared methylphenidate with placebo. Most of the studies were small and included about 70 children with an average age of 10 years (age ranged from 3 to 18 years). Most studies were short, averaging about a month; the shortest study lasted only one day, and the longest 425 days. Most of the research has been done in the USA.
Based on teacher ratings compared to placebo or no treatment, methylphenidate:
– may reduce ADHD symptoms (21 studies, 1728 children)
– may not cause serious adverse effects (26 studies, 3673 participants)
– may cause more non-serious adverse effects (35 studies, 5342 participants)
– may improve general behavior (7 studies, 792 participants)
– may not affect quality of life (4 studies, 608 participants)
Limitations of evidence
Our confidence in the evidence is limited for several reasons. Often, the people who participated in the studies might have known what treatment the children were taking, which could affect the results. In many studies, the results were not fully reported, and for some outcomes, the results varied between studies. The studies were small and used different scales to measure symptoms. In addition, most of the studies have only lasted for a short period of time, which makes it impossible to assess the long-term effects of methylphenidate. About 41% of the research was wholly or partly funded by the pharmaceutical industry.
How relevant is this evidence?
This is an update of a 2015 survey. The evidence is current to March 2022.
If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.
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Translation notes:
Translation: Airat Usmanovich Ziganshina. Editing: Ziganshina Lilia Evgenievna. Russian translation project coordination: Cochrane Russia – Cochrane Russia on the basis of the Russian Medical Academy of Continuing Professional Education (RMANPE). For questions related to this transfer, please contact: [email protected]
How to treat ADHD – Attention Deficit Hyperactivity Disorder?
Read the first part of the article (on diagnosing ADHD) here.
Passionate controversy accompanies the use of drugs. In the United States, stimulants are used to treat the symptoms of ADHD, the most common of which is Ritalin (methylphenidad). Their use is sharply criticized by some experts, the public, the World Health Organization expresses concern about them, but a number of medical agencies insist on the effectiveness and safety of stimulants.
Studies confirming the effectiveness of stimulants and counter-work demonstrating inefficiencies, harmful side effects, and the risk of cocaine addiction in adolescence in children who have taken stimulants for a long time could be devoted to a separate article.
Both in the West and in Russia, antipsychotic drugs (Sonapax, Neuleptil, Rispolept, Abilify, Seroquel) are widely used to reduce hyperactivity and excitability of a child. Meanwhile, studies show that these drugs reduce the volume of brain tissue, not to mention such side effects as weight gain, increased blood cholesterol levels, increased blood pressure, the development of diabetes, tremors, up to tardive dyskinesia.
In the UK, the right to prescribe antipsychotics is given not only to narrow specialists, but also to pediatricians. In 2011, the British found that over the past 10 years the number of children taking these drugs has doubled, and among them there are many who are barely 5 years old.
This made a strong impression on the government, which decided to allocate 32 million pounds to expand mental health services for children and adolescents.
As mentioned in the first part of the article, it is very important to conduct a medical examination of a child with ADHD. In some cases, by taking control of physical problems, it is possible to reduce the symptoms of hyperactivity and impaired attention. For example, this happens when the normal blood supply to the brain is restored after the correction of birth injuries of the cervical spine.
In Russia, to improve brain metabolism, increase cortical tone, children with ADHD are often prescribed nootropic drugs (piracetam, encephabol, akatinol memantine, glycine, phenibut). We often hear from doctors that they observe a positive effect of drugs in their practice, but their effectiveness has not been clinically proven.
The image of a child with an unnamed diagnosis of ADHD – inattentive in class, poorly in time, unorganized in everyday life – is often used to advertise multivitamins. I drank the Alphabet and immediately mastered the alphabet and other academic knowledge and skills. In fact, it is unlikely that multivitamins will produce just such an effect. This does not exclude the possibility that a number of specific nutrients may have a positive effect on ADHD symptoms.
There are studies (like this one) that show a lack of omega-3 fatty acids in children and adolescents with ADHD, as well as a positive effect of taking them (like this). The best source of omega-3 fatty acids is fish oil, which is beneficial in many ways and has no harmful side effects, except for individual intolerance.
Photo courtesy of huffingtonpost.com
In this French study, 40 children with symptoms of ADHD were given vitamin B6 (0.6 mg per 1 kg of body weight) and magnesium (6 mg per 1 kg of body weight) daily for 8 weeks. The study participants significantly decreased hyperactivity and aggressiveness, and improved attention. Children in the control group who took placebo showed no such changes. A few weeks after the end of the course, the symptoms of ADHD in children from the experimental group resumed, which also indicates that the improvements were provided precisely by the intake of B6 and magnesium.
For a child and adolescent with ADHD, dietary patterns are important. Some parents are very happy with the effects of a gluten-free/casein-free diet (eliminating the protein gluten found in wheat, rye and a number of other grains, and casein found in milk), which is often recommended for children with autism who share some of the common symptoms of ADHD. (Mercy published a detailed article on the gluten-free diet). Others praise the sugar-free diet (excluding polysaccharides, that is, sucrose and starches), which is also called the specific carbohydrate diet or paleo diet in Russian-language sources, and SCD, GAPS, Paleo Diet in English-language sources.
A recent meta-analysis by Danish scientists suggests that elimination diets that eliminate certain foods that provoke hyperactivity, impulsivity, and inattention gave the best results in ADHD. By the way, the same study also revealed the usefulness of fish oil for children with ADHD.
Experts advise parents to identify foods to which a child may have an individual intolerance. To do this, you need to rotate products, alternately removing them from the diet for a week or two, observing the severity of ADHD symptoms and evaluating the result.
Dr. Richard Sogn, a child psychiatrist and one of America’s leading experts on ADHD, believes that whatever is good for the brain is good for children with ADHD. First of all, their diet should be rich in protein in the form of meat, eggs, nuts, cheese, legumes. He advises to give these products to the child for breakfast, and also as a snack between lessons.
Carbohydrates are necessary, but in the form of vegetables and fruits, but sugar, sweets, flour products, rice and potatoes should be eliminated or severely limited. It is important to include fish and other sources of omega-3 fatty acids such as walnuts, Brazil nuts, olive oil, and canola oil in your diet.
The American Academy of Pediatrics recommends avoiding foods with preservatives and artificial food coloring in children with ADHD, and some experts believe that all food additives should be avoided.
The most important method of treating ADHD is behavioral therapy: for children, this is primarily Applied Behavior Analysis (ABA), for adolescents and young people – Cognitive Behavioral Therapy.
Applied Behavior Analysis is considered the gold standard in behavioral intervention for autistic children in the US and the UK, but is also being applied to children with ADHD.
In Russia, this method appeared not so long ago and mainly due to the efforts of parents-activists with the continuing resistance of domestic defectology and correctional pedagogy, who declared this therapy to be training. Such an opinion can only be formed with a very superficial acquaintance with this technique. In fact, it is based on a careful analysis of the child’s behavior, allowing to identify his strengths and weaknesses and create a carefully structured behavior modification program based on the encouragement of the desired behavior of the child.
Unfortunately, it is almost impossible to find a competent behavioral analyst and therapist outside the capital, but many parents complete distance courses, participate in conferences, seminars and webinars in order to learn the basics of therapy and help their child on their own. (You can learn more about this in the group “Autism Problem Center”).
There are also home behavioral strategies that experts recommend parents use :
- Daily routine is very important for a child with ADHD. Make it up and make sure your child follows it.
- Organize the space so that all the items the child needs (clothes, toys, school supplies) have a strictly defined place. This will allow the child to lose them less often.
- Avoid distractions, especially when the child is doing homework. Be sure to turn off the radio and TV during this time.
- Give the child a choice, but reduce the number of choices to make it easier. Offer a choice of two options for clothing, food, toys, so as not to create sensory and emotional overload.
- When you remind your child of the need to fulfill a particular duty, try to keep all explanations and instructions short and clear. If possible, avoid both persuasion and the threat of punishment.