The best way to treat ADHD is with what we call a 'multimodal' approach. Simply put, this means using a combination of different types treatments. For children and adolescents in school, this usually means;
During this counseling, different strategies to help the child deal with their impulsivity are discussed with the parents and parenting techniques decided on. Counseling is often in the form of psychoeducation, or education on ADHD. This component of the treatment may in fact be the most important factor when looking at the effectiveness of long-term treatment. Studies have shown that providing education on ADHD greatly increases the number of individuals that continue with their treatment long term. The more a family understands ADHD and how it affects their child, the better they will be at making informed choices. Treating ADHD includes; regular follow-up visits with a medical practitioner, continued support for families with information about ADHD and its management, patient, parent and teacher training, special educational accommodations and behavioural interventions.
- Educating Parents & Children on ADHD (ex: psychosocial interventions, including individual, group and family counseling),
- School Accommodations (put in place in the classroom through the special education system),
- Medication if required
If symptoms continue to be impairing medication may be considered as part of the treatment plan. Parents should expect to have an in-depth discussion with their physician about medication treatment, which symptoms are expected to decrease and which may not, and potential side effects before their child begins medication treatment. Parents need to be fully informed
of all the benefits and risks of any treatment, drug or non-drug, as well as the risks of not treating this disorder, for an informed decsision to be made.
In uncomplicated cases of ADHD, medication management is fairly straight forward and typically effective with minimal side effects. The type of medication that is most often used to manage ADHD, is stimulant medication. There are two basic compounds of stimulant medication; Methylphenidate (Ritalin) and Dextroamphetamine (Dexedrine). Stimulant medications are controlled substances and are therefore strictly regulated, however, they have been around for more than fifty years and thousands of published research papers are available detailing their safety and effectiveness.
In the last ten years, the development of time-released formulations that need to be taken only once a day, have significantly improved these same medications. A time-released medication helps to prevent medication levels from fluctuating or causing peaks and valleys during the day. These time-released medications usually cover the child during the whole school day and into the early evening. Some children do metabolize these medications more quickly than others and may not have coverage for as many hours. These medications are in a form that is difficult to abuse and children who are concerned about having to take medication at school are happier taking medication just once, at the start of their day. There are two Methylphenidate-based time-released medications available in Canada at this time: Biphentin and Concerta. The Dextroamphetamine-based medications available is Adderall XR and Vyvanse.
For more extensive information on medications please access our first and second line medication charts.
There is now also a non-stimulant medication available in Canada. It is classified as a noradrenalin reuptake inhibitor. This medication's ingredient is Atomoxetine Hydrochloride and the trade name is Strattera. Strattera stays in the child's system longer and may therefore be beneficial for those children who experience symptoms late into the evening. This medication may be your doctor's choice of treatment if your child experiences problems with anxiety or a tic spectrum disorder.
The first medication that your child tries may not always be the best one for them. Physicians should always start with a low dosage and increase it gradually. It may therefore take some time to discover that the first medication tried does not work. Fortunately, eighty percent of children respond to the first type of stimulant medication tried and of the twenty percent who do not, eighty percent of those respond to the other type of stimulant medication. Side effects may also be an issue with one type of stimulant medication and not the another. This trial and error approach does not mean that your doctor does not know what he/she is doing. Individuals react differently to medication and unfortunately at this time we have no way of knowing which medication will work best for your child without actually doing a drug trial.
Doctors are now able to improve the main symptoms of ADHD in a very short period of time, however medication should never be the only treatment used. A three-tier approach (called multimodal) is always recommended.
For detailed information on various medications for ADHD, dosages, costs and possible side effects, please click here.
For the management of simple medication-induced side effects such as sleep problems and a decrease in appetite, please click here
For detailed information on Medication Guidelines, please click here.
For the full listing of Guidelines of ADHD, please refer to the CADDRA 2011 Guidelines or visit www.caddra.ca.
Information on Alternative Treatment/Therapies
Canadian Pediatric Society's Psychosocial Paediatrics Committee article that you can access by clicking here.