Attention Deficit Hyperactivity Disorder (ADHD) is a clearly defined clinical condition and not just a label for naughty or badly brought up children.
In most cases of ADHD it is recommended that a combination of both medication and a structured advice, support and behavioural programme is the best way to manage the full range of problems experienced by those with ADHD.
The main medications licensed in the UK for ADHD are:
These medications enhance the ADHD child’s natural abilities to select, focus, shut out distraction and think before they act. They are not sedatives and do not dull the child’s faculties.
Methylphenidate has been proven to be effective in many clinical studies. In the United Kingdom it is marketed as Ritalin and Equasym. The effect of these stimulant medications lasts only for a few hours, so it is taken two or three times a day. The most common longer acting, once-daily, preparations available in the UK are Concerta XL, Equasym XL and Medikinet XL. The effects of these preparations can last 8 – 12 hours. These long acting medications must not be broken, crushed or chewed. The medication will not work properly unless it is swallowed whole. Although the capsule can be opened and the “beaded” contents mixed with a teaspoon of soft food like yoghurt or apple sauce and fed to the child as long as they do not chew it.
Sometimes short acting medications are given to ‘top up’. To mix two presentations of methylphenidate is not unusual. The top-up doses may be prescribed to be given in the morning to help the child focus in getting ready for school; when a child comes home from school to help him/her concentrate on the homework; and occasionally it may be prescribed for the early afternoon to help concentration in afternoon lessons.
Once the optimum dose has been established the child on stimulant medication may stop taking it at weekends and during school holidays, if agreed by the prescribing doctor and at the discretion of the parents.
Dexamfetamine and methylphenidate belong in the same class of medicines called stimulants. Elvanse is a common medication being prescribed, the capsules contain lisdexamfetamine, an inactive pro-drug of dexamfetamine, and once it is in the blood it is gradually converted into dexamfetamine. Sometimes a child who does not respond to methylphenidate will respond to dexamfetamine.
Atomoxetine (marketed as Strattera) acts in a slightly different way and is not classed as a stimulant. This medication is usually taken once a day.
NB: Atomoxetine is not a stimulant and must be taken every day.
There are several medications available to treat ADHD and it may take time for the prescribing doctor to find the optimum medication for a specific child. Usually, medication is started at a low dose and gradually increased to an optimum dose of a period of weeks.
There is no standard dose for any of the medications used to treat ADHD. The dose varies from child to child.
While ADHD medications frequently provide effective treatment they may have side effects.
The common side effects of stimulant medications include:
- Sleeplessness (though this can be a symptom of ADHD as well as a side effect).
- Reduced appetite.
- Nervousness and depressed mood – uncommon.
- Tics and mannerisms can occur – uncommon.
The common side effects of atomoxetine include:
- Abdominal pain.
- Nausea and vomiting.
- Reduced appetite.
When a child has been diagnosed with ADHD the doctor will initially review the child regularly every few weeks until an optimum dose is established.
The child will then be reviewed every 3 – 6 months to monitor progress, growth and blood pressure. The parents and school teacher will also be asked to help monitor the child’s progress by providing up to date reports and completing the ‘medication monitoring form’.
Useful tips to make swallowing tablets or capsules easier.
- Take a couple of swallows of fluid before you take the tablet/capsule – it makes the tongue and throat more slippery.
- Swallow the tablet/capsule with a teaspoon of soft food such as yoghurt or mousse.
- Put the tablet/capsule on the tip of your tongue and take a sip of fluid, tilt your head back and swallow.
Learning to live with ADHD can be very difficult for a child.
Living with an ADHD child can be very difficult for parents and siblings.
Medication can help the child to be less impulsive and more attentive but the child has to learn strategies that will help him/her master the skills of everyday living. Likewise the parents may need to acquire specific parenting skills to address the difficulties of living with an ADHD child.
With the use of parenting skills and behaviour strategies the child can develop the techniques to overcome the symptoms of ADHD and master the skills for everyday living.
This will help the child to:
- Increase educational attainment.
- Improve interactions with family members, education staff and their peers.
- Enable the child to learn age appropriate self help skills.
- Improve their self esteem.
There are local courses available for parents (and others working with children) that provide the opportunity to learn specific techniques to help care this challenging group of children. ADHD and challenging behaviour specific Parenting skills courses are offered by Addup. Other parenting courses are sometimes available at local schools and adult education centres.
For other support agencies please visit this page.
Parenting the ADD Child (Practical Strategies for Managing Behaviour Problems in Children with Add and ADHD).
Understanding Attention Deficit Disorder.
Dr Christopher Green & Dr Kit Chee
Understanding Your Hyperactive Child: The essential guide for parents.
Professor Eric Taylor