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Attention-deficit hyperactivity disorder (ADHD) in children

Treatments and drugs
Thanks By MayoClinic.com staff

Standard treatments for ADHD in children include medications and counseling. Other treatments to ease ADHD symptoms include special accommodations in the classroom, and family and community support.

Medications
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating
ADHD.

Stimulant medications for ADHD include:
* Methylphenidate (Ritalin, Concerta, Daytrana)
* Dextroamphetamine-amphetamine (Adderall)
* Dextroamphetamine (Dexedrine)

Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of the brain chemicals called neurotransmitters. These ADHD medications help improve the core signs and symptoms of inattention, impulsivity and hyperactivity sometimes dramatically. However, effects of the drugs wear off quickly. Additionally, the right dose varies from child to child, so it may take some time in the beginning to find the correct dose.

Stimulant drugs are available in short-acting and long-acting forms.
* The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours.
* Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours and is approved for use in children between the ages of 6 and 12. While the long-lasting effects mean your child won't need to take medication as often, it can take up to three hours to start working. For it to work in the morning, the patch needs to be put in place early while your child is still asleep.

Stimulant medication side effects...
The most common side effects of stimulant medications in children include:

* Decreased appetite
* Weight loss
* Problems sleeping
* Irritability as the effect of the medication tapers off

A few children may develop jerky muscle movements, such as grimaces or twitches
(tics), but these usually disappear when the dose of medication is lowered.
Stimulant medications may also be associated with a slightly reduced growth rate in
children, although in most cases growth isn't permanently affected. There's been
some concern about using stimulants to treat preschoolers who have ADHD.

ADHD medications and heart problems
Although a rare occurrence, several heart-related deaths have occurred in children
and adolescents taking stimulant medications. Your child's doctor will want to be
sure your child doesn't have any signs of a heart condition before prescribing a
stimulant. Experts disagree about whether children need an extensive evaluation
before taking these medications. The American Heart Association has said that every
child should have a heart test called an electrocardiogram (ECG) before getting
stimulant medications for ADHD, while other organizations such as the American
Academy of Pediatrics say that a thorough history and physical exam is enough to
screen for heart problems.

Nonstimulant medication
Atomoxetine (Strattera) is generally given to children with ADHD when stimulant
medications aren't effective or cause side effects. In addition to reducing ADHD
symptoms, atomoxetine may also reduce anxiety. Given one or two times a day,
atomoxetine side effects can include nausea and sedation. It can also cause reduced
appetite and weight loss.

Atomoxetine has been linked to rare side effects that include liver problems. If
your child is taking atomoxetine and develops yellow skin (jaundice), dark-colored
urine or unexplained flu symptoms, contact the doctor right away.

There's been some concern that children and adolescents taking atomoxetine have an
increased risk of suicidal thinking. Although atomoxetine has never been linked to
an actual suicide, contact your child's doctor if you notice any signs of suicidal
thinking or other signs of depression.

Other medications used to treat ADHD include:

* Antidepressants. These medications are generally used in children who don't
respond to stimulants or atomoxetine or have a mood disorder as well as ADHD.
* Clonidine (Catapres) and guanfacine (Tenex). These are high blood pressure
drugs shown to help with ADHD symptoms. They may be prescribed to reduce tics or
insomnia caused by other ADHD medications, or to treat aggression caused by ADHD.

Giving medications safely
Making sure your child takes the right amount of the prescribed medication is very
important. Parents are understandably concerned about stimulants which are similar to amphetamines and the risk of abuse and addiction. But dependence hasn't been reported in children who take medications at the proper dose. That's because drug levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse ADHD medications. To keep your child's medications safe and to make sure your child is getting the right dose of medication at the right time:

* Administer medications carefully. Children and teens shouldn't be in charge of
their own ADHD medication.
* At home, keep medication locked in a childproof container. An overdose of
stimulant drugs is serious and potentially fatal. Young children are especially
sensitive to drug overdoses.
* Don't send supplies of medication to school with your child. Deliver any
medicine yourself to the school nurse or health office.

ADHD counseling and therapy
Children with ADHD often benefit from counseling or behavior therapy, which may be
provided by a psychiatrist, psychologist, social worker or other mental health care
professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling can help both ADHD and the coexisting problem.

Counseling types include:

* Psychotherapy. This allows older children with ADHD to talk about issues that
bother them, explore negative behavioral patterns and learn ways to deal with their
symptoms.
* Behavior therapy. Teachers and parents can learn behavior-changing strategies
for dealing with difficult situations. These strategies may include token reward
systems and timeouts.
* Family therapy. Family therapy can help parents and siblings deal with the
stress of living with someone who has ADHD.
* Social skills training. This can help children learn appropriate social
behaviors.
* Support groups. Support groups can offer children with ADHD and their parents
a network of social support, information and education.
* Parenting skills training. This can help parents develop ways to understand
and guide their child's behavior.

The best results usually occur when a team approach is used, with teachers, parents,
and therapists or physicians working together. You can help by making every effort
to work with your child's teachers and by referring them to reliable sources of
information to support their efforts in the classroom.

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