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ADHD Treatment Guidelines

New Treatment Recommendations for Children with ADHD

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Updated October 18, 2008

The American Academy of Pediatrics, to compliment the policy statement on Diagnosis and Evaluation of the Child With ADHD, has released a policy statement on the Treatment of the School-Aged Child With ADHD. Together, these two policy statements offer physicians evidence based recommendations to diagnose and treat their patients with ADHD.

Among the conclusions and recommendations that are stated in this policy statement are that attention deficit hyperactivity disorder should be recognized as a chronic condition and that a child-specific, individualized treatment program should be developed for children with a goal of maximizing function to improve relationships and performance at school, decrease disruptive behaviors, promote safety, increase independence and improve self esteem.

Other recommendations include that stimulant medications and/or behavior therapy are appropriate and safe treatments for ADHD and that children should have regular and systematic follow-up to monitor goals and possible side effects. One of the strongest, and I think most helpful, recommendations in the policy statement is what to do with children who don't respond to standard treatments. Too often, if a child doesn't respond to a medication or continues to have problems, the treatment is stopped and he is left to continue to do poorly at school, have behavior problems and poor relationships with others. Instead, the AAP recommends that 'when the selected management for a child with ADHD has not met target outcomes, clinicians should evaluate the original diagnosis, use of all appropriate treatments, adherence to the treatment plan, and presence of coexisting conditions.'

For children with ADHD who continue to have problems with core symptoms, including inattention, hyperactivity and impulsivity, if medication wasn't part of the initial treatment plan, then a stimulant medication should be considered and behavior therapy should be reinforced. Children who are already on a stimulant medication and are doing poorly, may be changed to a different stimulant medication.

Many of the statements and conclusions of this policy statement should be reassuring to parents, including that:

  • review and analysis of several studies have shown that stimulant medications
  • do work for the core symptoms of ADHD and in many cases 'improves the child's ability to follow rules and decreases emotional overactivity, thereby leading to improved relationships with peers and parents.'
  • side effects of stimulant medications are usually 'mild and short lived,' and for parents that worry about the effects of stimulant medications on their child's growth, that there is 'no significant impairment of height attained' in adult life.
The AAP policy statement also includes a brief review of medications used in the treatment of Attention Deficit Hyperactivity Disorder, including stimulants, which are first line treatments, and antidepressants, which are second line treatments and might be considered if 2 or 3 stimulant medications don't work for your child.

Stimulants include different formulations of methylphenidate:

  • short acting, such as Ritalin and Focalin, with a duration of 3-5 hours
  • intermediate acting, such as Ritalin SR, Metadate ER, and Methylin ER, with a duration of 3-8 hours
  • long acting, such as Concerta, Rilatin LA and Metadate CD, with a duration of 8-12 hours and which can be used just once a day
The other type of stimulant includes different formulations of amphetamine:
  • short acting, such as Dexedrine and Dextrostat, with a duration of 4-6 hours intermediate acting, such as Adderall and Dexedrine spansule, with a duration of 6-8 hours
  • long acting, such as Adderall-XR

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