Oct 03, 2023 / Behavioral Health
By Asia Hulse, PhD / Summit, Willow Creek
& Reagan Larsen, MD / Summit

ADHD Treatment

If your child has been diagnosed with ADHD, you’re not alone. As much as 7 percent of all children share this diagnosis. When it comes to treatment, it is important that you make the best choice for your child and your family. We want to help support you with this decision!

Treatment Guidelines

Did you know that treatment guidelines vary based on a child’s age and brain development? The American Academy of Pediatrics recommends the following:

4-5 years old:

1. Start with behavioral therapy and parent training in behavior management. This includes working with a therapist to implement techniques such as positive reinforcement, sticking to routines, ignoring unwanted behavior, setting limits, following through with consequences, and teaching emotional regulation skills.
2. Consider medication as a supplemental tool once behavior management practices are consistent.

6-11 years old:

• Consult with your doctor about developing a treatment plan that introduces medication and behavioral therapy simultaneously.
• Therapy includes the parent behavior management training described above, as well as self-monitoring interventions, executive functioning support in the classroom, providing frequent feedback about behavior and goals reached, and using visual supports to guide decisions, among others.
  • Example: Check-In/Check-Out is an evidence-based intervention that is implemented at school and encourages collaboration with parents as well (see figure below). It involves the child checking in with an adult while at school. The “school adult” can be a classroom teacher, specials teacher, or counselor, but ideally, someone with whom the child has a good relationship. Lastly, rewards and consequences can be given at home based on the child’s performance that day at school.

 

Check In/Check Out

 

 

12-18 years old:

• Medication is the preferred treatment with this age group.
• Behavioral interventions can be used to support specific skill development. These include time management strategies, utilizing alarms, organizational support and reminders, using a planner, etc.

Medication Overview

The decision to incorporate medication into your child’s treatment plan can have a number of benefits.  Benefits including the following based on data from the World Federation of ADHD, which is an international group of health experts that formulates public policy about ADHD:

• Improvement in grades
• Higher test scores
• Decrease in depression and suicidality
• Decrease in substance use
• Decrease in teenage pregnancy
• Reduction in criminality
• Decrease in injuries (traumatic brain injuries, bone fractures, emergency room admissions, car accidents, sexually transmitted infections, burns)

Medications

There are two types of medications used to manage ADHD: stimulants and nonstimulants. Symptoms of ADHD are thought to be linked to inefficient processing of information by certain types of neurons (brain cells) in the prefrontal cortex of the brain. Stimulant medications, such as methylphenidate and amphetamine, act at these neuron sites to increase signal strength by affecting the amounts of neurotransmitters, specifically norepinephrine and dopamine. This decreases symptoms of inattention, hyperactivity, and impulsivity.

Stimulant medications are given in the mornings and have a duration of 4-6 hours for short-acting medications and 8-12 hours for extended-release formulations. The most common side effect with stimulant medications is appetite loss while the medication is in the system. Less common side effects include headaches, abdominal pain, difficulty sleeping, increased heart rate and blood pressure, growth retardation (more common in younger children with chronic use), and mood changes.

Nonstimulant medications, such as guanfacine and atomoxetine, whose mechanism of action is not as well understood, can be useful in managing some of the hyperactivity and/or aggressive behaviors that may be present in ADHD, but often fail to improve focus and attention significantly. The most common side effect of nonstimulant medications is drowsiness, so these are often given at bedtime.

Your child’s physician will help monitor for these concerns with regular clinic visits that include checking your child’s weight and height, blood pressure, and heart rate, in addition to any reports of side effects and a physical exam.

Conclusion

Overall, your child’s treatment for any medical condition requires careful consideration of risks, benefits, and knowledge of the most up-to-date recommendations based on science. Talk with your pediatrician about the best treatment options for your child and to get help in guiding you through this process.