ADHD: what treatments work?

Transcription

1 Patient information from the BMJ Group ADHD: what treatments work? Caring for a child who has attention deficit hyperactivity disorder (ADHD) can put a strain on you and your family. If your child has been diagnosed with ADHD, there are treatments that can help your child behave better, so that he or she can learn and develop normally. The two main treatments for ADHD are medicines and a talking treatment (psychotherapy) called behaviour therapy. These treatments are often used together. We've looked at the best and most up-to-date research to produce this information. You can use it to talk to your doctor and decide which treatments are right for your child. Medicines Many parents are anxious about long-term medicines being prescribed for their children. Taking long-term medication is a big step and you need to be certain it s right for your child.you can use the information here to talk to your doctor so you can make a decision together. The most common treatment for ADHD is medicine to stimulate the nerves in the brain. It may seem strange to treat hyperactivity with stimulants. But stimulants have been used for many years to treat ADHD. The most commonly used stimulant is methylphenidate (brand name Ritalin). The second one is dexamfetamine (available as a generic). Both those stimulants come as tablets. Both medicines can help your child behave better. They should make your child less restless, less impulsive, and able to concentrate better. There hasn t been enough research to say which medicine works best. Neither of these medicines has been tested to see how well it works in the long term. So we don t know for certain how well they work if your child takes them for more than a year. If your child stops treatment, there's a good chance that their symptoms will come back. Methylphenidate comes in long-lasting versions, called Concerta XL, Equasym XL, and Medikinet XL. Taking a long-lasting tablet means your child will not have to take medicine at school. You need to consider the chances of your child getting side effects from these medicines. About half of all children get side effects, although these side effects often go away after a couple of weeks. But if they don't, doctors may prescribe a lower dose. The common page 1 of 4

2 side effects of stimulant drugs are having less appetite and losing weight, and finding it difficult to fall asleep. About 3 in 100 children get more serious side effects, such as depression, worrying, and feeling irritable. Some studies found that children may: Get twitches (tics) or jittery movements. These usually go away with time or if the dose of the medicine is lowered Have stomach-aches or headaches. Some doctors and parents worry that stimulants might stop children growing properly. We don't know for certain if this happens, as different studies have come to different conclusions. Your doctor should regularly check your child's height and weight, usually every six months. Some people are also anxious about whether stimulants could be misused and taken recreationally. But stimulants taken for ADHD do not offer the high that drug abusers seek. Also, some parents worry that taking stimulants will make their child more likely to become dependent on drugs or alcohol when the child is older. But there's no evidence that this is likely to happen. In fact, studies show that children with ADHD may be less likely to become dependent on drugs and alcohol if they're treated with stimulants. In addition, there have been some concerns that stimulants might increase the risk of sudden deaths or strokes in children and adults, especially those with heart defects. Doctors are advised not to prescribe stimulant drugs to anyone with heart defects or high blood pressure. Atomoxetine (brand name Strattera) is a newer medicine used for ADHD. You can take it as a single dose or as two doses. Unlike methylphenidate or dexamfetamine, atomoxetine isn't a stimulant. It works differently from stimulants. If your child is prescribed atomoxetine, there is a good chance his or her symptoms will improve. Your child may get side effects from atomoxetine. Common side effects include having less appetite and losing weight, feeling sick, feeling tired, and getting indigestion. Your doctor should monitor your child s height and weight, to make sure that atomoxetine isn't stopping your child growing properly. There have been some reports of more serious problems with atomoxetine. A few people taking it have had serious liver damage, but this is very rare. However, if your child becomes ill while taking atomoxetine, you should see your doctor straight away. Also, a small number of children and young people taking atomoxetine are more likely to think about killing themselves.you should watch out for signs of depression or suicidal thoughts if your child takes this medicine. Atomoxetine also causes seizures (fits) in some people. page 2 of 4

3 There are some other drugs your doctor might try if the ones above don't work, or they stop working. They include clonidine (brand name Catapres), modanifil (Provigil), and bupropion (Zyban). But these aren't used very often. Behaviour therapy The main non-drug treatment for ADHD is a talking treatment (psychotherapy) called behaviour therapy. Behaviour therapy may help you and your child cope better with ADHD. There s not enough research to show how well it works on its own, but it can help if your child is also taking a stimulant drug, such as methylphenidate. In behaviour therapy, a trained therapist counsels and supports your child and family, and teaches you how to manage ADHD behaviour. The term behaviour therapy covers a wide range of treatments. They are based on the idea that all behaviour is learnt and can be unlearnt. Some treatments involve working with a therapist one to one. Others involve group activities.your child's teacher may also be involved in the therapy. Behaviour therapy usually involves a system of rewards and penalties. The aim is to help children plan ahead and choose the right behaviour. You may feel more supported and better able to cope if your child's treatment includes therapy as well as medicine. Therapy may also allow your child to manage his or her behaviour with a lower dose of medicine. This can reduce the risk of side effects. Diet and supplements Some people think that ADHD is linked to what a child eats. But the research is not of a very high quality and more research is needed to be certain. Some studies have found that children with ADHD have lower levels of essential fatty acids (EFAs) than other children. One summary of the research (a systematic review) that looked at studies in children with ADHD found that fatty acid supplements can help ADHD symptoms. The quality of the studies wasn't very high, so more research is needed before we can decide if supplements of fatty acids can help. There have been suggestions that children with ADHD need extremely high levels of certain vitamins or minerals. But when children were given 10 times the normal dose of vitamin and mineral supplements, their symptoms of ADHD did not improve. Very high doses of certain vitamins can be dangerous. If you are considering supplements for your child, check with your doctor first. Some people think that food allergies could contribute to the symptoms of ADHD. So children might be helped by avoiding certain foods, to find and treat any allergies (this is called an elimination diet). But there s no good research to show whether elimination diets work. It s best to talk to your doctor if you think your child may have an allergy, or if you are considering a special diet for your child. page 3 of 4

4 Some parents think their child's behaviour improves when they're not eating or drinking food containing artificial colours, flavourings, and preservatives, and salicylates (salicylates are chemicals found in some plants).this is called the Feingold diet.there's not enough good research to say if this works.there is some evidence that children who are sensitive to certain foods can benefit from avoiding foods that contain artificial colouring. Many parents say that not giving children sweets or sugary drinks helps, because they believe their children become hyperactive afterwards. But, even though there have been several studies, there is no convincing evidence that sugar or artificial sweeteners cause the symptoms of ADHD. Being helped to cope with your child's behaviour Many parents of children with ADHD advise other parents not to try to cope with their child's problems on their own. Getting help and treatment for your child can make all the difference. Parent education programmes aim to help parents improve their relationship with their child. The idea is that this will help the child to be less disruptive. This approach is only recommended for children up to 12 years of age. Parent education programmes are usually done in a group. You learn about how best to talk to your child and understand your child's feelings. There is some research to show these programmes can help improve children s behaviour, and also help parents feel less stressed. Where to get more help You might also want to contact a self-help group for families affected by ADHD. The National Attention Deficit Disorder Information and Support Service (ADDISS) is a UK registered charity providing advice and support to families coping with ADHD. You can see their website at or call The National Institute for Health and Care Excellence (NICE), which advises the government on healthcare, has issued advice about how to treat ADHD. NICE recommends that children under 6 should not be offered drug treatments. Instead, the focus should be on parent education. For older children, parent education and talking treatments are usually tried before medication. However, children with severe ADHD may have drug treatment straight away. For more details, see their information for the public on their website at This information is aimed at a UK patient audience. This information however does not replace medical advice. If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These leaflets are reviewed annually. page 4 of 4

5 ADHD: what treatments work? Last published: Sep 16, 2015 page 5 of 4