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ADHD in Children Health Center

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ADHD: An Update on Diagnosis and Treatment for Kids

Diagnosing attention deficit hyperactivity disorder (ADHD) is sometimes controversial. But for children with the condition, treatment options are working.

Drug Treatment continued...

More than 200 scientific studies have found the medications effective, although the stimulants can cause reduced appetite, sleeping difficulties, and tics, such as excessive blinking or facial grimacing.

The FDA recently approved Strattera, a nonstimulant drug that affects the brain chemical norepinephrine and helps improve ADHD symptoms -- but without the stimulant side effects. Strattera can cause abdominal pain, headache, reduced appetite, dry mouth, and insomnia. This drug, along with the stimulants already mentioned, is FDA-approved for children, Stein says.

Antidepressants are also sometimes prescribed because they can help decrease impulsivity, hyperactivity, and aggression. Even though these drugs are not specifically approved for ADHD, doctors sometimes prescribe them "off label."

More than 70% of children do well on the stimulants or Strattera, says Stein. And of the 30% who don't -- those whose symptoms do not improve or who have side effects such as nervousness or insomnia -- half of those will do well on other medications such as antidepressants.

Behavior Modification

Behavior therapy conducted by psychologists, psychiatrists, or social workers is typically the other mainstay treatment. This approach is based on the principle of rewarding positive behaviors. Parents and teachers work on a "target" behavior and then move on to the next one. For instance, a teacher might tell a child, "If you can stay in your seat all morning, you will get a star. Three stars and you get a privilege." Next, they might work on getting the child to turn in homework promptly, Stein says.

Behavior modification also involves using punishment correctly, says Ann Abramowitz, PhD, chair of the advisory board for CHADD (Children and Adults with Attention Deficit Disorders) and a psychologist at Emory University, Atlanta. That means taking away a privilege or using time-outs when behavior is unacceptable. Can behavior modification alone work? "It's feasible [to manage] kids without medication," she says, but it requires a consistent approach from everyone involved.

In a landmark study, the Multimodal Treatment Study of Children with ADHD, research shows that both medication alone and medication coupled with behavior therapy were effective in curbing ADHD behaviors. However, children who were given drugs and behavior therapy were able to take lower doses of medication.

According to the National Institute of Mental Health analysis of the study, some children did very well with behavior therapy alone. "Therefore," the analysis concludes, "medication alone is not necessarily the best treatment for every child, and families need to pursue other treatments, either alone or in combination with medication." (This study was done before Strattera was approved and therefore did not include that medication.)

Behavior therapy alone requires patience and a commitment to see it through. "Everyone has to do it the same," says Michelle Blanton of Durango, Colo., referring to the use of the strategies to reward good behavior and effectively punish unacceptable behavior. Blanton's son Tyler, now 9 and in third grade, was diagnosed with ADHD in first grade, and had typically used medication and behavior therapy during the school year, going off his medications during the summer. Tyler did so well this summer, she says, that he had no privileges taken away at his day camp. She's hoping to continue to control his behavior naturally. "His doctor thinks he might be ready to do behavior modification [alone]" for the next school year, she says.

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