ADHD (attention deficit hyperactivity disorder) is characterized by inattention, hyperactivity, and the inability to control impulses. It affects an estimated 5.2 million school-age children in the U.S.
Everyone, especially younger children, may have symptoms of ADHD from time to time. But with ADHD, the ability to function with daily activities is affected. A diagnosis of ADHD can be hard to make, and evaluation must be made by a specialist.
There are several different approaches to treating ADHD. But research suggests that for many children, the best way to manage the symptoms is a multimodal approach.
What Is a Multimodal Approach to Treating ADHD?
Multimodal treatment involves multiple methods of treatment that work together to help a child with ADHD.
The main components of this approach are medications, behavioral therapy, and education.
Medications and ADHD
The most commonly prescribed medications for ADHD are stimulants. These include:
- Amphetamine (Adzenys XR-ODT)
- Amphetamine/Dextroamphetamine (Adderall, Adderall XR)
- Dexmethylphenidate (Focalin, Focalin XR)
- Dextroamphetamine ( Dexedrine or Dextrostat)
- Lisdexamfetamine (Vyvanse)
- Methylphenidate (Concerta, Daytrana, Metadate, Methylin, Quillivant XR, Ritalin)
Some of these medications are available in long or short acting formulations.
Non-stimulant medications used to treat ADHD, include:
ADHD medications are used to improve children's ability to concentrate and work. Sometimes, a doctor must prescribe different medications or different dosages before finding the best treatment for a child. Doctors and parents need to carefully monitor children taking medications for ADHD.
Side effects of ADHD medicines can include:
- Decreased appetite
- Sleeping difficulties
- Skin discoloration (with patches)
- Upset stomach
Most side effects are minor and improve with time. In some cases, doctors may lower a medication dosage to relieve side effects.
The FDA recommends that a thorough medical history and exam, including an evaluation of underlying heart or psychiatric problems, be done as part of an ADHD treatment plan. A higher risk of strokes, heart attacks, and sudden death among patients with existing heart conditions has been linked to use of ADHD medications. An increased risk of psychiatric problems has also been linked to ADHD medications.
Medical Devices and ADHD
The FDA has recently given approval to a device called Monarch external Trigeminal Nerve Stimulation (eTNS) System to treat children age 7 to 12 years old. the cell phone-sized device delivers mild stimulation to electrodes which are attached to a patch worn on the patient's forehead. Those electrical pulses interact with the part of the brain which is believed to be responsible for ADHD.
Behavioral Therapy and ADHD
Behavioral therapy is designed to help a child curb problematic behaviors. This may involve helping the child learn to organize time and activities. Or it could help a child complete homework. It may also involve helping the child control their impulses and responses to emotional stimuli.
Education and ADHD
Educating parents about the disorder and its management is another important part of ADHD treatment. For parents, this may include learning parenting skills to help the child manage their behavior. That would involve skills such as giving positive feedback for desirable behaviors, ignoring undesirable behaviors, and giving time-outs when the child's behavior is out of control. In some cases, the child's entire family may be involved in this part of the treatment.
The Benefits of Multimodal Treatment
Treatment guidelines call for behavior therapy as the preferred treatment for preschool children with ADHD. Medicine may be prescribed if further treatment is needed. For older children with ADHD, age 6 and older, an approach that includes both behavior therapy and medication is preferred.
Researchers have found that multimodal treatment was particularly effective for improving social skills in children in highly stressful environments. It also was effective for those with anxiety and depression in addition to ADHD.
Children who receive multimodal treatment may need lower doses of medications compared to children only receiving medication.
Individualized Treatment Plan
A multimodal plan is effective for most children. The particular therapy and medication, however, will vary depending on the individual child. Doctors, parents, and teachers need to work together to develop and administer the best treatment for each child and family.