How is it treated and managed?

Children with ADHD / ADD require integrated care that addresses a wide range of personal, social and educational needs. Treatment is comprised of:

• Medication
• Non-pharmacological treatment

The Community Adolescent Mental Health Services (CAMHS) team will make the diagnosis of ADD/ADHD. However, the level of ongoing management will depend on the severity of the condition with GP involvement for mild conditions and Paediatric or Child Psychiatric specialists being involved for moderate conditions. Ongoing CAMHS involvement will only be present in children with a severe level of functional restriction. ADHD Specialist nurses are usually part of the CAMHS team and tend to manage the condition with the Consultant.

Medication

The main drugs used in the treatment of ADHD tend to start working fairly rapidly, even within a few days; the optimal dosage and effectiveness of treatment should be known within 2 months. The differing preparations of ADHD drugs, such as slow release preparations are used to address issues around convenience, improving compliance and reducing problems schools have in storing and administering controlled drugs. However, there is no difference in the effectiveness of medication based on the type of preparation.

Medication does not work for all children, nor does it work to the same degree in everyone. So despite being on medication, there are significant aspects of a child’s behaviour (especially if diagnosed with a specific behavioural problem) that may remain unchanged or only slightly altered, therefore their needs persist. Therefore corroborative information such as a medical report, additional treatment (other than medication) and supervision requirements at school are important in establishing likelihood of needs.

Stimulants

In England, prescription of stimulant drugs for ADHD / ADD has almost doubled from 1998 to 2004. Treatment with stimulants has the paradoxical effect of decreasing activity level and increasing attention. Targeted symptoms include impulsivity, distractibility, poor task adherence, hyperactivity, and lack of attention. These are first-line therapy and the most effective treatment. Methylphenidate is the usual drug of choice. The full range of stimulants that may be used to treat ADHD / ADD is as follows:

Atomoxetine (Strattera)

A non-stimulant selective norepinephrine reuptake inhibitor has been effective in many people with ADHD / ADD. It may be useful in those who have significant adverse effects with stimulants. It may also be used in combination with a stimulant since it appears to increase the clinical effects of the stimulant, allowing for clinical effectiveness with a low dose and decreasing the likelihood of adverse effects. However, cases of reversible liver failure have been attributed.

Additional Treatment

(adjunct therapy for associated behaviour, tics, hyperactivity or sleeping problems) includes:

• Risperidone or Risperdal®
• Clonidine hydrochloride or Catapres®
• Imipramine
• Melatonin
  

Non-pharmacological treatment

• Psychotherapeutic techniques – including cognitive behavioural therapy (CBT) and behaviour management strategies; for adolescents, coaching and participating in a support group may be useful
• Family training and education – teaches families about the condition and trains parents in behavioural management
• Educational support – providing specific support for the child in the classroom. Periodic feedback from teachers about school performance can assist in monitoring.