If you or your child has recently been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), a common neurodevelopmental disorder that causes difficulty focusing, hyperactivity, and impulsiveness, you may be grappling with an array of questions and concerns—including how to navigate the treatment options that exist and what to expect in the coming years.

ADHD Treatment Strategies

For parents hearing that their child has ADHD, the diagnosis can be especially stressful. “Sometimes parents don’t know what ADHD is or what it means, which can lead to a lot of misconceptions and fears,” says Gayani DeSilva, MD, child & adolescent psychiatrist and author of A Psychiatrist’s Guide: Helping Parents Reach Their Depressed Tween.

While ADHD can’t be “cured,” people of all ages often respond well to common treatment options. For children, whose brains are still developing, how they respond to treatment will be different from adults. But the good news is that with the right supports in place at an early stage (by school-age), most children’s development progresses at about the same pace as their peers who don’t have an ADHD diagnosis.

What Is the Best Treatment for ADHD?

Treatment for ADHD for people of all ages should be comprehensive. For kids, this often requires combining pharmacological treatments and occupational therapy, DeSilva says. Adults may benefit from a combination of medication and behavioral therapy and/or assistance with organization or structure. Both kids and adults may also sometimes try alternative treatments, as well, to help manage symptoms.

Is It Safe to Give ADHD Medications to Kids?

Parents are often concerned about giving medication to their young children, yet Dr. DeSilva points out that although it may sound counterintuitive, the latest best practices reveal that not giving medication is a bigger danger than actually giving them for many kids with ADHD.

“When children are five or six years old, they typically learn how to focus, how to learn, and how to be successful,” Dr. DeSilva explains. Yet kids with ADHD may be challenged because their symptoms can interfere with these typical developmental stages. That makes getting treatment as early as possible particularly important for kids with ADHD. Dr. DeSilva points out that the right treatment can help relieve some of the distractions and allow normal brain development to progress.

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Drugs That Help with ADHD Symptoms

There are several basic categories of medications used today for ADHD.

Stimulants

Stimulants are the most common medications used to treat ADHD.  Stimulants target dopamine, which is a chemical in the brain that helps control motivation, movement, and emotional responses. Since kids with ADHD are often hyperactive or overstimulated, it may be confusing to think of giving a child with ADHD a stimulant. But experts explain that by giving a child a stimulant, he or she won’t need to seek outside stimulation and will be able to focus and learn. This is important, according to Dr. DeSilva, since this enables kids with ADHD to learn age-appropriate skills and to build important pathways in the brain.

Types of Stimulants

There are a variety of stimulants that are used on children. The easiest to tolerate and most effective option for children and adolescents is methylphenidate (which goes by different brand names, including Concerta, Ritalin, Daytrana, Aptensio XR, Metadate CD, Methylin, Quillivant XR), according to a study published online in Lancet Psychiatry in August 2018.

Other common options include Amphetamine/Dextroamphetamine (such as Adderall, Adderall XR), Dextroamphetamine (Dexedrine, ProCentra, Zenzedi), and Dexmethylphendiate (Focalin). These short-term drugs can last for about three to six hours and may need to be taken a few times a day.

There are also longer-lasting options (referred to as “intermediate”) that work for about 8 to 12 hours, such as Amphetamine sulfate (brand name Evekeo), Methylphenidate (this includes Ritalin SR, Metadate ER, Methylin ER), and Adzenys XR-ODT. Then there are even longer-term options that can work for 12 to 16 hours or longer, including Dexmethylphenidate (Focalin XR), Dextroamphetamine (Adderall XR), Lisdexamfetamine (Vyvanse), Methylphenidate (such as Concerta, Daytrana, Metadate CD, Quillivant XR, Quillichew ER, Ritalin LA).

“Keep in mind that the pharma companies say the medications act for a certain (long) length of time, the actual length of action may be shorter by several hours,” Dr. DeSilva explains. “Parents may rely on the provider’s experience with these medications for guidance on the length of actual action.”

Overnight Option

While most stimulants are given in the morning, a new option of methylphenidate hydrochloride (called HLD200) for kids and adults was also recently approved by the FDA. This new medication is unique because it is given at bedtime for results throughout the following day. Although the premise holds much promise in terms of helping make mornings easier for kids with ADHD, parents should wait until any new medication has been on the market for at least a year before having their children use it, cautions Edward (Ned) Hallowell, MD, president of the Hallowell Centers, with locations in Boston, New York City, San Francisco, and Seattle. Dr. Hallowell is also author of a number of books including Driven to Distraction, Delivered from Distraction, and Super Parenting for ADD.

Concerns about Side Effects

While stimulants can be very effective in children, they also cause some concerns for parents, both doctors Hallowell and DeSilva agree. For instance, stimulants can be an appetite suppressant which can result in weigh loss for adults and can affect the growth of children. So parents should plan ahead to be sure their children are eating enough around the dosing schedule. Dr. DeSilva recommends making sure kids eat a healthy breakfast that includes protein, such as eggs, before they take their stimulant. During the day while they are on the medication, she suggests providing small snacks and then serving a large dinner.

Other side effects that can occur with stimulants include elevated heart rate and blood pressure, insomnia, and personality changes. Dr. Hallowell points out that if your child has any of these negative effects,  it’s okay to just stop using it. Gradually weaning your child down is not necessary since these medications are short-acting, and the side effects are temporary. The side effects will cease when the dose wears off.

Addiction and Abuse Concerns

Dr. DeSilva also points out that some parents worry that stimulants can be addictive but points out that the potency of stimulants is 1/10,000 of the potency of recreational drugs. “Nonetheless, college students and others do sometimes abuse stimulants; but actually, children with ADHD who are treated are less likely to abuse drugs than kids with untreated ADHD,” she stresses. To prevent all kids and teens from abusing drugs, she recommends parents keep the medication in a lockbox and dole out the dose on a daily basis.

Non-Stimulant Medications

While stimulants are the “gold standard” for ADHD, according to Dr. Hallowell, non-stimulant medications are an alternative option for children and adults with ADHD for whom stimulants just aren’t a good fit. Non-stimulant medications help to increase a neurotransmitter in the brain called norepinephrine, which can help control attention. Some choices include Atomoxetine (Strattera), Guanfacine XR (Intuniv and Tenex), and Clonidine XR (Kapvay). Many of these come in short- and longer-term versions. They can lower blood pressure and may cause some sedation in some children, Dr. DeSilva notes. However, she says that the side effects are generally quite mild.

Occasionally, physicians may prescribe hypertension medication (typically used for high blood pressure) to treat ADHD, or antidepressants (commonly used for mood disorders). Both of these approaches can be worth discussing with your child’s psychiatrist or pediatrician when more common approaches don’t work.

Are ADHD Medications for Adults Different?

Adults typically take the same medication as children and adolescents. Short-term, intermediate, and longer-acting forms of methylphenidates are commonly used. The right medication for adults is usually determined based on how long symptoms need to be controlled and any side effects the user experiences.

Exploring Other ADHD Treatment Options

When exploring ADHD treatments for your child, a combination of options will likely have the most benefit, according to Dr. Hallowell.

Occupational Therapy (OT)

“Occupational therapy for children really focuses on neurodevelopment, and managing the connection between their environment and their own reflexes and what is going on in the brain and beyond,” Dr. DeSilva says. OT for kids with ADHD includes activities to strengthen fine motor skills (such as holding a pencil, picking up and releasing blocks, and cutting with child-safe scissors), activities to develop gross motor skills (such as throwing a ball), and activities to regulate sensory processing (such as spinning and swinging). “Most OT workshops will look like a big gym with climbing walls, zipline, swings, a mini trampoline, a ball pit, and much more.”

While OT is not necessary for adults, other forms of behavioral health therapy or strategies can be an important component of the treatment equation.

Holistic Approaches

There are many alternative or holistic approaches that can be used for children and adults with ADHD.

This includes weighted blankets (one type sold specifically for kids and adults with ADHD is called SensaCalm). The product looks like a blanket but is filled with items like rice, millet, or beads. This provides deep-touch pressure stimulation that helps users with ADHD (including those with related sensory issues) to focus better when they are using it.  Children with ADHD may also wear a weighted vest or clothing in the classroom. Another way to achieve a similar effect is by weighting backpacks with cans or heavy books that can help provide that beneficial input that helps children with ADHD to focus better.

Music therapy or sound therapy (such as HUSO) is another way to help people with ADHD. In the simplest terms, the organization inherent in a piece of music provides structure for kids who have trouble regulating their brain pathways. Music also increases chemicals in the brain that help with regulation, memory, and motivation.

Nutritional Supplements and CBD Oil

Dr. Hallowell says that many people try various nutrients, supplements, vitamins, and herbs. “It’s important to experiment and see what works for you,” he points out. “I often suggest patients take fish oil for Omega 3s and Vitamin D,” he adds. “Both are good supplements for everyone,” he says.

“I also recommend ‘the other Vitamin C,’ which is positive human connection and interaction,” Dr. Hallowell says, as well as physical exercise, which can also be helpful.

In addition, some people also try CBD oil to treat ADHD, but Dr. DeSilva does not recommend it. “When parents or adult patients ask me about it, I suggest that they talk to their primary care doctors and neurologists to do their own research to understand the pros and cons, but I advise against this. I see too many kids who get panic attacks from using cannabis because such treatments work differently in kids than adults since their brain development is different,” she says. The key for both kids and adults is working with a psychiatrist you trust to guide you on how best to manage your symptoms and monitor your progress.

Living with ADHD

“There is a lot more to treating ADHD than medication,” Dr. Hallowell reminds people. In order to help your child thrive, parents need to educate themselves on the condition and their options and how to help your child access the best options for his or her needs. This also requires working closely with your child’s doctors and not being afraid to try something new, or stopping when something you tried isn’t working. He says that parents can also keep the diagnosis in perspective, since ADHD may sound overwhelming, but he stresses that it isn’t necessarily a negative.

“It’s important not to think about what is wrong with your child, but rather, what’s right with him or her,” he stresses. People with ADHD have a number of gifts, such as creativity, intuition, and drive. Therefore, he says that people should recognize these assets that make people living with ADHD so special.

 

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Last Updated: Nov 16, 2018