From the Guidelines
The treatment of ADHD in children should involve a multimodal approach combining behavioral therapy and medication, with the primary care clinician prescribing FDA-approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both 1. The most recent and highest quality study recommends that for elementary and middle school–aged children (age 6 years to the 12th birthday) with ADHD, the primary care clinician should prescribe US Food and Drug Administration (FDA)–approved medications for ADHD, along with parent training and behavioral management (PTBM) and/or behavioral classroom intervention (preferably both PTBM and behavioral classroom interventions) 1. Some key points to consider in the treatment of ADHD in children include:
- First-line medication treatment usually includes stimulants such as methylphenidate (Ritalin, Concerta) at doses starting at 5-10mg daily for immediate-release formulations or 18mg daily for extended-release, gradually titrated based on response and side effects 1.
- Alternatively, amphetamine-based medications like Adderall may be used starting at 5mg daily 1.
- For children who don't respond to or tolerate stimulants, non-stimulant options include atomoxetine (Strattera) starting at 0.5mg/kg/day and increasing to 1.2mg/kg/day, guanfacine (Intuniv), or clonidine (Kapvay) 1.
- Behavioral therapy should focus on parent training, classroom management strategies, and teaching organizational skills 1.
- Treatment should be monitored regularly with feedback from parents and teachers to assess effectiveness and adjust as needed 1.
- Side effects of medications should be closely monitored, including appetite changes, sleep disturbances, and potential effects on growth 1.
- The goal of treatment is to improve attention, reduce impulsivity and hyperactivity, and enhance academic performance and social functioning 1.
- Treatment typically continues as long as symptoms persist and benefits outweigh any side effects, with periodic attempts to reduce medication to assess continued need 1.
From the FDA Drug Label
For the Inattentive Type, at least 6 of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes, lack of sustained attention, poor listener, failure to follow through on tasks, poor organization, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful For the Hyperactive-Impulsive Type, at least 6 of the following symptoms must have persisted for at least 6 months: fidgeting/squirming, leaving seat, inappropriate running/climbing, difficulty with quiet activities, “on the go,” excessive talking, blurting answers, can’t wait turn, intrusive. Atomoxetine capsules are indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Dosing of children and adolescents up to 70 kg body weight - Atomoxetine capsules should be initiated at a total daily dose of approximately 0.5 mg/kg and increased after a minimum of 3 days to a target total daily dose of approximately 1.2 mg/kg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening.
The treatment of ADHD in children involves a comprehensive treatment program that includes:
- Psychological measures
- Educational measures
- Social measures
- Drug treatment with atomoxetine, which should be initiated at a dose of approximately 0.5 mg/kg and increased to a target dose of approximately 1.2 mg/kg. The decision to prescribe drug treatment will depend on the chronicity and severity of the patient’s symptoms 2.
From the Research
Treatment Guidelines for ADHD in Children
The treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children involves a combination of behavioral interventions, pharmacotherapy, and other complementary strategies.
- Behavioral treatments are recommended for preschool-aged children and may be helpful at older ages, including parent training, classroom management, and peer interventions 3.
- Medications, such as psychostimulants (e.g., methylphenidate and dextroamphetamine), are recommended as first-line therapy for older children and are most effective for the treatment of core ADHD symptoms 3, 4.
- Coexisting conditions, such as anxiety, learning, mood, or sleep disorders, should be identified and treated 3.
Pharmacotherapy Options
- Stimulant drugs, including methylphenidate and amphetamine salts, are the first-line treatment options for ADHD 4.
- Non-stimulant drugs, such as atomoxetine, are alternative options but are less efficacious than stimulants 4.
- Lisdex-amfetamine is a prodrug of dextroamphetamine with low feasibility for abuse 4.
Combined Treatment Approach
- Combined treatment with behavioral intervention and stimulant medication is a recommended approach for many children with ADHD 5.
- A psychosocial-first approach is supported by research, with stimulant medication added as necessary 5.
Complementary and Integrative Treatments
- Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity are considered evidence-based complementary treatments for ADHD 6.
- Meditation, yoga, and sleep hygiene are safe and partially effective adjunctive treatment strategies 6.