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WWK03 Managing Medication for Children and Adolescents With ADHD

WWK03 Managing Medication for Children and Adolescents With ADHD

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Published by Cyndi Whitmore

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Published by: Cyndi Whitmore on Nov 08, 2009
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01/06/2013

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NationalResourceCenteron AD HD
A program of CHADD
www.help4adhd.org
1-800-233-4050
3
WHAT WE KNOW
Manan Medcaton oChden and Adoecentwth AD/HD
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I
ndividuals with attention-decit/hyperactivity disorder (AD/HD) experience chronic problems withinattention and/or hyperactivity-impulsivity to a greaterdegree than the average person. It is a liespan disorder,aecting children, adolescents and adults.
Attention-decit/hyperactivity disorder (AD/HD) is a common neurobiologicalcondition aecting 5-8 percent o school age children.
1,2,3,4,5,6,7
with symptomspersisting into adulthood in as many as 60 percent o cases (i.e. approximately 4%o adults).
8,9
While it has long been thought that boys with AD/HD outnumbergirls by approximately 3 to 1, recent research shows that the actual numbers may be nearly equal.Although some media coverage questions the validity o the AD/HD diagnosis,medical proessional groups such as the American Academy o Pediatrics(AAP), American Academy o Child and Adolescent Psychiatry (AACAP), andAmerican Medical Association (AMA) have recognized the strong scienticevidence or this disorder. “AD/HD is one o the best-researched disorders inpsychiatry, and the overall data on its validity are ar more compelling than
*
Tis act sheet should be read together with
What We Know #7: Psychosocial reatment  or Children and Adolescents with AD/HD.
 
What We KnoW
3
 
Managing Medication or children and adolescents with ad/hd
 
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or most mental disorders and even many medicalconditions,” according to the American MedicalAssociation Council on Scientic Aairs.
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Multiple studies have been conducted to discover thecause o the disorder. Te exact causes o AD/HD remainelusive, but research indicates that at least three separateyet interactive brain regions have been associated withthe condition. Research also clearly indicates that AD/HD tends to run in amilies. More than 20 geneticstudies have shown evidence that the disorder is largely an inherited, neurologically-based condition. AD/HD isa complex trait, and complex traits are typically the resulto multiple interacting genes. Problems in parenting orlie situations may make AD/HD better or worse, butthey do not cause the disorder.Without early identication and appropriate treatment,AD/HD can have serious consequences that includeschool ailure and drop out, depression, conductdisorder, ailed relationships, underachievement in theworkplace, and substance abuse. When appropriately treated, persons with AD/HD can lead productive andsatisying lives.
DiAgNOsis Of AD/HD
Determining i a child has AD/HD is a multiacetedprocess. Many biological and psychological problemscan contribute to symptoms similar to those exhibited by children with AD/HD. For example, anxiety, depression,and certain types o learning disabilities may causesimilar symptoms.Tere is no single test to diagnose AD/HD. Tereore,a comprehensive evaluation is necessary to establisha diagnosis, rule out other causes, and determine thepresence or absence o co-existing conditions. Such anevaluation requires time and eort and should includea clinical assessment o the individual’s academic, socialand emotional unctioning, and developmental level.A careul history should be taken rom the parents,teachers and the child, when appropriate. Checklistsor rating AD/HD symptoms and ruling out otherdisabilities are oen used by clinicians.Tere are several types o proessionals who can diagnoseAD/HD, including school psychologists, privatepsychologists, clinical social workers, nurse practitioners,neurologists, psychiatrists, pediatricians, and othermedical doctors. Regardless o who does the evaluation,the use o the Diagnostic and Statistical Manual o Mental Disorders (DSM) diagnostic criteria or AD/HD is necessary. An exam by a medical proessional isalso important and should include a thorough physicalexamination, including an assessment o hearing and vision, to rule out other medical problems that may be causing symptoms similar to AD/HD. In rare cases,persons with AD/HD may have a thyroid dysunction.
TrEATMENT fOr AD/HD
Getting appropriate treatment or AD/HD is very important. Tere may be very serious negativeconsequences or persons with AD/HD who do notreceive adequate treatment. Tese consequences caninclude low sel esteem, social and academic ailure,substance abuse, and a possible increase in the risk o antisocial and criminal behavior.reating AD/HD in children requires medical,educational, behavioral and psychological interventions.Tis comprehensive approach to treatment is called“multimodal” and consists o parent and child educationabout diagnosis and treatment, behavior managementtechniques, medication, and school programming andsupports. reatment should be tailored to the uniqueneeds o each child and amily.Behavior interventions are oen a major componentor children who have AD/HD. Important strategiesinclude being consistent, using positive reinorcement,and teaching problem-solving, communication andsel-advocacy skills. Children, especially teenagers,should be actively involved as respected members o theschool planning and treatment teams.
What We Know
 #7
: Psychosocial reatment or Children and Adolescents
“…the Multimodal Treatment Studyo Children with AD/HD showedthat children who were treated withmedication alone...and childrenwho received both medicationmanagement and behavioraltreatment had the best outcomes.”
 
What We KnoW
3
 
Managing Medication or children and adolescents with ad/hd
 
3
with AD/HD
, provides more detailed inormation aboutpsychosocial treatments that have been ound helpul orAD/HD.School success may require a range o interventions.Many children with AD/HD can be taught in the regularclassroom with minor adjustments to the environment.Some children will require additional assistance usingspecial education services. Tis service may be providedwithin the regular education classroom or may require aspecial placement outside o the regular classroom thatts the child’s unique learning needs.Te National Institute o Mental Health conducted amajor research study, called the Multimodal reatmentStudy o Children with AD/HD, involving 579 childrenwith AD/HD-combined type. Each child receivedone o our possible treatments over a 14-monthperiod—medication management, behavioral treatment,combination o the two, or usual community care. Teresults o this landmark study showed that children whowere treated with medication alone, which was careully managed and individually tailored, and children whoreceived both medication management and behavioraltreatment had the best outcomes with respect toimprovement o AD/HD symptoms.
11,12
 Combination treatment provided the best results interms o the proportion o children showing excellentresponse regarding AD/HD and oppositional symptomsand in other areas o unctioning (e.g., parenting,academic outcomes).
13
Overall, those who receivedclosely monitored medical management had greaterimprovement in their AD/HD symptoms than childrenwho received either intensive behavioral treatmentwithout medication or community care with lesscareully monitored medication.For more inormation on evaluating treatments, pleaseread
What We Know #6: Complementary and Alternativereatments.
Tis act sheet provides checklists orspotting unproven remedies and evaluating mediareports on treatments.
THE rOlE Of MEDiCATiON
For most children with AD/HD, medication is anintegral part o treatment. It is not used to controlbehavior. Medication, which can only be prescribedby certain medical proessionals i needed, is usedto improve the symptoms o AD/HD so that theindividual can unction more eectively. Researchshows that children and adults who take medication orsymptoms o AD/HD usually attribute their successes tothemselves, not to the medication.
PsyCHOsTiMulANT MEDiCATiONs
Psychostimulant compounds are the most widely usedmedications or the management o AD/HD symptoms.Psychostimulant medications were rst administeredto children with behavior and learning problems in1937. Despite their name, these medications do notwork by increasing stimulation o the person. Rather,they help important networks o nerve cells in thebrain to communicate more eectively with each other.Between 70-80 percent o children with AD/HD respondpositively to these medications. For some, the benetsare extraordinary; or others, medication is quite helpul;and or others, the results are more modest. Attentionspan, impulsivity, and on-task behavior oen improve,especially in structured environments. Some childrenalso demonstrate improvements in rustration tolerance,compliance, and even handwriting. Relationships withparents, peers and teachers may also improve.Medication does not cure AD/HD; when eective, italleviates AD/HD symptoms during the time it is active.Tus it is not like an antibiotic that may cure a bacterialinection, but more like eyeglasses that help to improve vision only during the time the eyeglasses are actually worn. Aer reviewing the scientic evidence, the AMAreported that “pharmacotherapy, particularly stimulants,has been extensively studied. Medication alone generally provides signicant short-term symptomatic andacademic improvement” and “the risk-benet ratio o stimulant treatment in AD/HD must be evaluated andmonitored on an ongoing basis in each case, but ingeneral is highly avorable.”
14
Common psychostimulant medications used in thetreatment o AD/HD include methylphenidate (Ritalin,Concerta, Metadate, Focalin), mixed salts o a single-entity amphetamine product (Adderall, Adderall XR),and dextroamphetamine (Dexedrine, Dextrostat).Methylphenidate, amphetamine, and mixed salts o amphetamine are now available as both short- and long-acting preparations. Short-acting preparations generally last approximately 4 hours; long-acting preparationsare more variable in duration—with some preparationslasting 6-8 hours, and newer preparations lasting 10-12

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