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Health A-Z

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Harvard Medical School

Treatment

Although no treatment eliminates ADHD completely, many helpful options are available. The goal of treatment is to help children improve social relationships, do better in school, and keep their disruptive or harmful behaviors to a minimum. Medication can be very helpful, and it is often necessary. Drug treatment by itself is rarely the answer. Medication and psychotherapy together usually have the best results. For example, a behavioral program may be put in place where structured, realistic expectations are set.

Stimulants, such as methylphenidate (Ritalin) and forms of amphetamine (Dexedrine), have been used for many decades. They are relatively safe and effective for most children to help them focus their thoughts and control their behavior. With the development of long-acting forms of stimulants, one dose in the morning can provide a day-long effect.

Despite their name, stimulants do not cause increased hyperactivity or impulsivity. If the disorder has been properly diagnosed, the medication actually has the opposite effect. Common mild side effects are decreased appetite, weight loss, stomachaches, sleep problems, headaches and jitteriness. Adjusting the dose can often help eliminate these problems. Stimulant drugs are associated with some serious concerns and side effects.

  • Tics. There is some evidence that tics (uncontrolled movements) are more likely in patients with a family history of tic disorders, but that is still controversial.

  • Substance abuse. Although stimulant drugs can be and are abused, newer research shows that they may actually reduce the risk of substance abuse for people with ADHD.

  • Growth delays. Experts disagree about the effects of stimulants on growth. There is some evidence that children taking stimulants grow at a rate that is less than expected. Some doctors recommend stopping stimulants periodically during periods of expected growth.

  • Cardiovascular risk. Children taking stimulants do show small increases in blood pressure and heart rate. But major heart complications in children, teens and adults taking these drugs are extremely rare. Stimulants do not bring an excessive cardiovascular risk in children and adolescents, except in patients who already had underlying heart defects or disease.

Since such risks vary widely depending on the individual, it is important to discuss the potential benefits and risks of each treatment with your doctor.

Another potential problem, which is not strictly speaking a side effect, is that stimulants can find their way to people other than the person being treated for ADHD. Called "diversion," it is fairly common among adolescents and young adults. The drugs are most often taken to improve academic performance. Some individuals do take stimulants to get high.

Other non-stimulant medications are also available to treat ADHD. Atomoxetine (Strattera) is as effective as stimulants for treating ADHD. It works by a different chemical mechanism than stimulants. Atomoxetine is relatively safe, but carries a rare risk of liver toxicity. The antidepressant, bupropion (Wellbutrin), is helpful in some cases. It is also generally well-tolerated, but it should not be given to people with a history of seizures.

Other treatment approaches, used alone or in combination, may include:

  • Behavioral therapy This refers to techniques that try to improve behavior, usually by rewarding and encouraging desirable behaviors and by discouraging unwanted behaviors and pointing out the consequences.

  • Cognitive therapy This is psychotherapy designed to change thinking to build self-esteem, stop having negative thoughts and improve problem-solving skills.

  • Social skill training Developing social skills improves friendships.

  • Parent education and support Training classes, support groups and counselors can help to teach and support parents about ADHD, including strategies for dealing with ADHD-related behaviors.

Because many children with ADHD also are troubled by poor grades and school behavior problems, schools may need to provide educational adjustments and interventions (such as an individualized educational plan) to promote the best possible learning environment for the child.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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