From the Guidelines
The recommended treatment for pediatric ADHD typically involves a multimodal approach combining behavioral therapy and medication, with stimulant medications like methylphenidate and amphetamine-based medications being considered first-line pharmacological treatments for children 6 years and older, as supported by the most recent evidence from 1.
Key Considerations
- For children 6 years and older, stimulant medications like methylphenidate (Ritalin, Concerta) and amphetamine-based medications (Adderall, Vyvanse) are considered first-line pharmacological treatments 1.
- Non-stimulant options include atomoxetine (Strattera), guanfacine (Intuniv), and clonidine (Kapvay), which may be preferred for patients with stimulant side effects, substance abuse concerns, or comorbid tic disorders 1.
- For children under 6, behavioral therapy is recommended as the initial approach before considering medication 1.
- Behavioral interventions should include parent training, classroom management strategies, and skills training for the child 1.
- Regular monitoring of growth, blood pressure, heart rate, and potential side effects is essential during medication treatment 1.
Treatment Approach
- The effectiveness of ADHD medications stems from their ability to increase dopamine and norepinephrine levels in the brain, improving attention, impulse control, and executive functioning 1.
- Treatment plans should be individualized based on symptom severity, comorbidities, and the child's specific needs and response to interventions 1.
- A multimodal approach combining behavioral therapy and medication is likely to provide optimal care, but the decision about therapies is heavily dependent on acceptability by, and feasibility for, the family 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 recommended treatment options for pediatric patients with Attention Deficit Hyperactivity Disorder (ADHD) include:
- Atomoxetine capsules as an integral part of a total treatment program that may include other measures (psychological, educational, social)
- Dosing:
- For children and adolescents up to 70 kg body weight: initiate at 0.5 mg/kg/day and increase to a target dose of 1.2 mg/kg/day
- For children and adolescents over 70 kg body weight: initiate at 40 mg/day and increase to a target dose of 80 mg/day
- Administration: can be taken with or without food, and can be discontinued without being tapered 2
From the Research
Treatment Options for Pediatric Patients with ADHD
The recommended treatment options for pediatric patients with Attention Deficit Hyperactivity Disorder (ADHD) include:
- Behavioral interventions, such as parent training, classroom, academic, and peer interventions 3
- Stimulant medication treatment 4
- Combined treatments, which represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option 3, 4
- Behavioral parent training (BPT) programs, which have demonstrated significant improvement in frequency of problem behaviors associated with ADHD 5
Treatment Sequencing
Research suggests that beginning treatment with behavioral intervention can produce better outcomes overall than beginning treatment with medication 6
- Adding medication secondary to initial behavior modification can result in better outcomes on primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication 6
- Normalization rates on teacher and parent ratings are generally high when treatment is initiated with behavioral intervention 6
Diagnosis and Treatment Guidelines
The diagnosis and treatment of ADHD in the pediatric population should follow specific criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition Text Revision 7
- Guidelines recommend behavioral and/or stimulant therapy as first-line therapy based on age 7
- Understanding the differences in formulation, efficacy, and safety of stimulant products is essential to optimize efficacy and safety for patients 7
Effectiveness of Behavioral Parent Training Programs
Behavioral Parent Training (BPT) programs have demonstrated significant improvement in frequency of problem behaviors associated with ADHD 5