Hyperkinetic disorder

Treating ADHD

Treatmentfor attention deficit hyperactivity disorder (ADHD) can help relieve the symptoms and make the condition much less of a problem in day-to-day life.

ADHD can be treated using medication or therapy, but a combination of bothis often best.

Treatmentis usually arranged by a specialist, such as a paediatrician or psychiatrist, although the condition may be monitored by your GP.

Medication

There arefive types of medication licensed for the treatment of ADHD:

methylphenidate
dexamfetamine
lisdexamfetamine
atomoxetine
guanfacine

These medications aren't a permanent cure for ADHD, butmay help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.

In the UK, all of these medications are licensed for use in children and teenagers. Atomoxetine is also licensed for use in adults who had symptoms of ADHD as children.

If you weren't diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are suitable for you.

If you or your child is prescribed one of these medications, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.

Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

Methylphenidate

Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

Methylphenidate can be used by teenagers and children with ADHD over the age of six. Although methylphenidate isn't licensed for use in adults, it may be taken under close supervision from your GP and specialist.

The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).

Common side effects ofmethylphenidate include:

a small increase in blood pressure and heart rate
loss of appetite, which can lead to weight loss or poor weight gain
trouble sleeping
Headaches
stomach aches
mood swings

Dexamfetamine

Dexamfetamine is also a stimulant medication, which works in a similar way tomethylphenidate by stimulating areas of the brainthat play a part in controlling attention and behaviour.

Dexamfetamine can be used by teenagers and children with ADHD over the age of three. Although it's not licensed for use in adults, it may be taken under close supervision from your GP and specialist.

Dexamfetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.

Common side effects ofdexamfetamine include:

decreased appetite
mood swings
agitation and aggression
dizziness
headaches
diarrhoea
nausea and vomiting

Lisdexamfetamine

Lisdexamfetamine is a similar medication todexamfetamine, andworks in the same way.

It can be usedby children with ADHDover the age of six if treatment with methylphenidate hasn't helped.You may continue to take it into adulthood if your doctor thinks you're benefitting from treatment.

Lisdexamfetamine comes in capsule form, which you or your child usually take once a day.

Common side effects of lisdexamfetamine include:

decreased appetite, which can lead to weight loss or poor weight gain
aggression
drowsiness
dizziness
headaches
diarrhoea
nausea and vomiting

Atomoxetine

Atomoxetine works differently to other ADHD medications.

It's known as a selective noradrenaline reuptake inhibitor (SNRI), which meansit increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, andincreasing the amount can aid concentration and help control impulses.

Atomoxetine can be used by teenagers and childrenover the age of six. It's also licensed for use in adults if symptoms of ADHD are confirmed.

Atomoxetine comes in capsule form, which you or your child usually take once or twice a day.

Common side effects of atomoxetine include:

a small increase in blood pressure and heart rate
nauseaand vomiting
stomach aches
trouble sleeping
dizziness
headaches
irritability

Atomoxetine has also been linked to some more serious side effects that it's important to look out for, including suicidal thoughts and liver damage.

If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.

Guanfacine

Guanfacine acts on part of the brain to improve attention and it also reduces blood pressure.

It's used for ADHD in teenagers and children if other medicines are unsuitable or ineffective.

Guanfacine is usually taken as a tablet once a day, in the morning or evening.

Common side effects include:

tiredness or fatigue
headache
abdominal pain
dry mouth

Therapy

As well as taking medication, different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treatingadditional problems, such as conduct or anxiety disorders, that may appearwith ADHD.

Some of the therapies that may be used are outlined below.

Psychoeducation

Psychoeducation means that you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour therapy

Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.

If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour.

For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent training and education programmes

If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour.

You may also be offered parent training before your child is formally diagnosed with ADHD.

These programmes are usually arranged in groups of around 10-12 parents. A programme usually consists of 10-16 meetings, which each last up to two hours.

They aim to teach parents and carers about behaviour management (see above), while increasing confidence in your ability to help your child and improveyour relationship.

Social skills training

Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. A CBT therapist would tryto change how your child feels about a situation, which would in turn potentially change their behaviour.

CBT can be carried out with a therapist individually or in a group.

Other possible treatments

There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidencethese work, and they shouldn't be attempted without medical advice.

Diet

People with ADHD should eat a healthy, balanced diet.Don'tcut out foods before seeking medical advice.

Some people may notice a link betweentypes of food and worsening ADHD symptoms. For example, sugar, food colourings and additives,and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerances to wheat or dairy products, which may add to their symptoms.

If this is the case, keep a diary of what you eat and drink, and what behaviour this causes. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements

Some studies have suggestedthat supplements ofomega-3and omega-6 fatty acidsmay be beneficial in people with ADHD, althoughthe evidence supporting this is very limited.

It's advisable totalk to your GP before usingany supplements, becausesome can react unpredictably with medication or make it less effective.

You should also remember that some supplements shouldn't be taken long term, as they can reach dangerous levels in your body.

Medically Reviewed by a doctor on 30 Nov 2016

Articles for hyperkinetic disorder

Introduction

ADHD stands for Attention Deficit Hyperactivity Disorder, is a condition that comprises a variety of symptoms including: reduced attention span, hyperreactivity, or depending on the situation, apathy (patient is disinterested or apathetic in situations where their behavior should be otherwise). This condition may affect children or adults. Usually, this condition is diagnosed when children begin going to school, around the age of 6 or 12 years old. This condition is sometimes accompanied with a disruption of the normal sleep cycle, and increased anxiety. Parents must consult with specialized teachers and medical professionals for the diagnostication of ADHD.

Symptoms of ADHD

ADHD symptoms include:1. Lack of attention This includes a short attention spam, and easily distracted by whatever is going on around them, they make frequent mistakes while doing homework, they forget or lose their belongings, they complete work slowly, and submit it behind deadlines, they do not heed the advice of parents or teachers, have a tendency to become asiocial or problematic in relation to their peers. 2. Hyper-reaction and hypo-reactionThis includes an inability to remain calm, especially when they are in a quiet environment, excessive talking and movement, fidgeting, they cannot stand in a queue, they make thoughtless decisions, prone to interrupting others loudly, have a skewed ability to gauge risk.Many patients may exhibit a combination of the above, others may not. In adults, other symptoms may be visible, such as a lack of attention for detail, trying to perform many tasks at once, disorganized, answering loudly and interrupting others, etc. During the patient's transition from child to adult, many of the symptoms of ADHD become reduced or less visible, at least in 65% of patients up to 25 years old.

Causes of ADHD

The causes of ADHD are not completely known, albeit researchers have been able to discover a combination of factors that may be reponsible for this condition. These factors include:1. Genetic factor: You can be more predisposed to developing ADHD, if your parents also have ADHD. Children of parents with ADHD are 4 times more likely to develop ADHD. 2. Researchers have been able to observe differences in brain function between what is called a neutorypical brain and an ADHD brain.3. Other potential causes or risk factors include premature birth, being born underweight, brain damage in the uterus, trauma during birth or in the early days or years following birth, the consumption of alcohol, tobacco or other drugs during pregnancy, the exposure to toxic substances at an early age etc.

Diagnosing ADHD

The following steps can be taken in order to diagnose a patient with ADHD. If you are a parent, and notice that something is not right with your child, you should speak to their teacher, and take additional care to carefully follow your child's progress. Furthermore, you may decide to meet with a medical professional, who will most likely ask you for the following details: the symptoms you have noticed, when they have begun , whether the symptoms occur while your child is at school or at home, whether the symptoms occur daily, whether the child has difficulty socializing, whether a significant event has occured in your family recently (such as divorce or the death of a loved one), and if you have a family history of ADHD or other conditions. A doctor may decide in employing in a period of probation for around 10 weeks in order to observe the symptoms, how frequent and aggravated they are, and depending on the result, they may refer you to a joint consulatiton with a psychiatrist, pediatrician, a disability specialist and a therapist. They conduct a physical examination and a conversation with you and your child. In order for an ADHD diagnosis to be made, your child has to exhibit at least 6 or more hyperactivity symptoms, or 6 or more hypoactivity symptoms. In the case of adults, a thorough patient history must be taken, in order to be able to discover vital information about the patient's childhood, which is usually when ADHD symptoms become visible.

Treating ADHD

Treatment consists in alleviating symptoms. Especially for younger ages affected by this condition, it is highly important to employ treatment with therapy sessions with an ADHD specialist. In order to alleviate the symptoms, medication is often used. They usually aid the patient to concentrate better, be less impulsive, feel calmer and find it easier to study and learn.Examples of medication used to treat ADHD includes methylphnidate, dexamfetamine, lisdexamfetamine. Other medications include atomocetine, guanfacine, etc. Side effects for these types of medication range from mild to severe. It is important to carefully monitor the symptoms of your child in order to be able to stop medication when the symptoms have subsided. For all ages affected by ADHD, it is recommended to follow a treatment plan that includes psychoeducation, group therapy, training of parents and teachers, social training, cognitive therapy (a type of therapy that teaches the patients how they think and act and helps them change their behavioral patterns). It is also important to supervise the diet of affected individuals in order to avoid the consumption of foods high in sugar, artificial pigments or cafeine. These compounds may aggravate the symptoms.

Living with ADHD

Useful advice for parents of children or young adults suffering from ADHD includes:Keeping a journal where you can plan out their daily activities, handing out clearly defined tasks for them to complete, setting clear boundaries and deadlines for the completion of the task, establish a positive reward system, make sure to shelter the individual from situations known to frustrate them or cause them to lose control, enforcing an exercise regimen and a healthy diet which does not include foods that may cause aggravation of symptoms, enforce a healthy sleeping regimen, and avoid activities before sleep such as watching TV or using a computer.

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