ADHD Management
ADHD can have considerable impact on the lives of children when managed poorly. It can particularly disrupt a child’s education. ADHD can present with many co-morbidities that can also impact a child’s wellbeing and academic life. These comorbid conditions include:
mood disorders (eg anxiety, depression)
disruptive behaviour disorders (eg oppositional defiant disorder, conduct disorder)
developmental disability (eg learning and language disorders, neurodevelopmental disorders such as autism spectrum disorders)
other medical conditions (eg sleep apnoea, epilepsy)
Therefore, addressing the symptomology of ADHD, and any coexisting conditions is imperative to improve outcomes for paediatric patients.
When managing ADHD, it can broadly be defined into two categories: Nonpharmacological management (without drugs) and pharmacological management (with drugs).
Nonpharmacological Management of ADHD in Children
Nonpharmacological management of ADHD should involve the child, family or carers, and teachers. It should outline the treatment approach and development goals.
Psychoeducation should be provided to the child, parents and carers which includes information about ADHD, comorbid conditions that can coexist and the various treatment options. Developing a strong relationship with the school is important because school staff are often best placed to evaluate the effective of the treatment plan.
Other interventions include:
Social and organisation skills training
Cognitive training
Parent behaviour training
Classroom management measures (eg strategic positioning the child in the classroom)
Seeing an Occupational Therapist to review impact on daily living and classroom environment
While many people believe diet modification will help ease symptoms, it is not indicated unless there is a link between dietary exposure and ADHD symptoms. Paediatricians also recommend exercise to help kids regulate their energy levels.
A helpful resources for parents or carers is ADHD Australia.
Pharmacological Management of ADHD in Children
Pharmacotherapy is the second line management for ADHD in children and should only be prescribed by clinicians with expertise in using psychotropics in children; this is typically a paediatrician.
The first line medication that may be prescribed is stimulants. These include: dexamphetamine, Lisdexamphetamine, methylphenidate. They work to improve attention, decrease impulsiveness and reduce hyperactivity. They should not be used in children under 6 years of age, unless in exceptional circumstances and under the supervision of a specialist.
It is important to be aware of side effects of stimulant medication, which includes more active bowel movements and a reduced appetite. Kids should eat before taking their medication, and parents and carers should monitor how much their child is eating at school.
The management of ADHD is complex and involves many professions, but we hope the above has provided a short and succinct outline of what to expect if your child is diagnosed with ADHD.
In light of this, you can find the link to a very comprehensive resources here
References
Used in conjunction with the Australia Electronic Therapeutic Guidelines
Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD practice guidelines. 4th ed. Toronto, ON: CADDRA; 2018. http://www.caddra.ca/canadian-adhd-practice-guidelines/
National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE; 2018. https://www.nice.org.uk/guidance/NG87
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2019;144(4). https://www.ncbi.nlm.nih.gov/pubmed/31570648
Key references: Diagnosis of attention deficit hyperactivity disorder in children
Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD practice guidelines. 4th ed. Toronto, ON: CADDRA; 2018. http://www.caddra.ca/canadian-adhd-practice-guidelines/
National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE; 2018. https://www.nice.org.uk/guidance/NG87
Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, et al. European clinical guidelines for hyperkinetic disorder -- first upgrade. Eur Child Adolesc Psychiatry 2004;13 Suppl 1:I7–30. https://www.ncbi.nlm.nih.gov/pubmed/15322953
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2019;144(4). https://www.ncbi.nlm.nih.gov/pubmed/31570648
Key references: Nonpharmacological management of attention deficit hyperactivity disorder in children
Bolea-Alamanac B, Nutt DJ, Adamou M, Asherson P, Bazire S, Coghill D, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2014;28(3):179–203. https://www.ncbi.nlm.nih.gov/pubmed/24526134
Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD practice guidelines. 4th ed. Toronto, ON: CADDRA; 2018. http://www.caddra.ca/canadian-adhd-practice-guidelines/
Feldman ME, Charach A, Belanger SA. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health 2018;23(7):462–72. https://www.ncbi.nlm.nih.gov/pubmed/30681665
McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007;370(9598):1560–7. https://www.ncbi.nlm.nih.gov/pubmed/17825405
National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE; 2018. https://www.nice.org.uk/guidance/NG87
Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R. Diet and ADHD, reviewing the evidence: a systematic review of meta-analyses of double-blind placebo-controlled trials evaluating the efficacy of diet interventions on the behavior of children with ADHD. PLoS One 2017;12(1):e0169277. https://www.ncbi.nlm.nih.gov/pubmed/28121994
Schab DW, Trinh NH. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr 2004;25(6):423–34. https://www.ncbi.nlm.nih.gov/pubmed/15613992
Stevenson J, Buitelaar J, Cortese S, Ferrin M, Konofal E, Lecendreux M, et al. Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies. J Child Psychol Psychiatry 2014;55(5):416–27. https://www.ncbi.nlm.nih.gov/pubmed/24552603
Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, et al. European clinical guidelines for hyperkinetic disorder -- first upgrade. Eur Child Adolesc Psychiatry 2004;13 Suppl 1:I7–30. https://www.ncbi.nlm.nih.gov/pubmed/15322953
Weber W, Newmark S. Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism. Pediatr Clin North Am 2007;54(6):983–1006; xii. https://www.ncbi.nlm.nih.gov/pubmed/18061787
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2019;144(4). https://www.ncbi.nlm.nih.gov/pubmed/31570648
Key references: Overview of pharmacotherapy for attention deficit hyperactivity disorder in children
Bolea-Alamanac B, Nutt DJ, Adamou M, Asherson P, Bazire S, Coghill D, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2014;28(3):179–203. https://www.ncbi.nlm.nih.gov/pubmed/24526134
Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD practice guidelines. 4th Toronto, ON: CADDRA; 2018. http://www.caddra.ca/canadian-adhd-practice-guidelines/
Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 2018;5(9):727–38. https://www.ncbi.nlm.nih.gov/pubmed/30097390
Feldman ME, Charach A, Belanger SA. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health 2018;23(7):462–72. https://www.ncbi.nlm.nih.gov/pubmed/30681665
National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE; 2018. https://www.nice.org.uk/guidance/NG87
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2019;144(4). https://www.ncbi.nlm.nih.gov/pubmed/31570648
Key references: Stimulants for attention deficit hyperactivity disorder in children
Bolea-Alamanac B, Nutt DJ, Adamou M, Asherson P, Bazire S, Coghill D, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2014;28(3):179–203. https://www.ncbi.nlm.nih.gov/pubmed/24526134
Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD practice guidelines. 4th ed. Toronto, ON: CADDRA; 2018. http://www.caddra.ca/canadian-adhd-practice-guidelines/
Ching C, Eslick GD, Poulton AS. Evaluation of methylphenidate safety and maximum-dose titration rationale in attention-deficit/hyperactivity disorder: a meta-analysis. JAMA Pediatr 2019;173(7):630–9. https://www.ncbi.nlm.nih.gov/pubmed/31135892
Feldman ME, Charach A, Belanger SA. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health 2018;23(7):462–72. https://www.ncbi.nlm.nih.gov/pubmed/30681665
Huss M, Duhan P, Gandhi P, Chen CW, Spannhuth C, Kumar V. Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity. Neuropsychiatr Dis Treat 2017;13:1741–51. https://www.ncbi.nlm.nih.gov/pubmed/28740389
National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE; 2018. https://www.nice.org.uk/guidance/NG87
Storebo OJ, Krogh HB, Ramstad E, Moreira-Maia CR, Holmskov M, Skoog M, et al. Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. BMJ 2015;351:h5203. https://www.ncbi.nlm.nih.gov/pubmed/26608309
Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, et al. European clinical guidelines for hyperkinetic disorder -- first upgrade. Eur Child Adolesc Psychiatry 2004;13 Suppl 1:I7–30. https://www.ncbi.nlm.nih.gov/pubmed/15322953
Vitiello B, Lazzaretto D, Yershova K, Abikoff H, Paykina N, McCracken JT, et al. Pharmacotherapy of the Preschool ADHD Treatment Study (PATS) children growing up. J Am Acad Child Adolesc Psychiatry 2015;54(7):550–6. https://www.ncbi.nlm.nih.gov/pubmed/26088659
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2019;144(4). https://www.ncbi.nlm.nih.gov/pubmed/31570648
