Treatment Options for Children with ADHD
For children diagnosed with ADHD, the recommended treatment approach varies by age and should include both medication and behavioral therapy, with medication being the primary intervention for school-aged children and adolescents. 1
Age-Based Treatment Recommendations
Preschool Children (4-5 years)
- First-line treatment: Evidence-based parent and/or teacher-administered behavior therapy 1
- Second-line treatment: Methylphenidate may be considered if:
- Behavioral interventions do not provide significant improvement
- Child has moderate-to-severe continuing functional impairment
- Starting dose should be lower than for older children due to slower metabolism 1
Elementary School Children (6-11 years)
- First-line treatment: FDA-approved medications for ADHD 1
- Stimulants (strongest evidence): methylphenidate or amphetamine derivatives
- Non-stimulants (in order of evidence strength): atomoxetine, extended-release guanfacine, extended-release clonidine
- Combined with: Evidence-based parent and/or teacher-administered behavior therapy
- Educational interventions: School accommodations, individualized instructional supports, and behavioral supports (often through IEP or 504 plan) 1
Adolescents (12-18 years)
- First-line treatment: FDA-approved medications for ADHD with the adolescent's assent 1
- Combined with: Evidence-based training and behavioral interventions
- Educational interventions: Similar to those for elementary school children 1
Medication Details
Stimulant Medications
Methylphenidate:
- Starting dose: 5 mg twice daily (immediate-release) or 10 mg once daily (extended-release)
- Titrate to achieve maximum benefit with minimum side effects 1
Amphetamine/Dextroamphetamine:
Non-stimulant Medications
- Atomoxetine:
- For children up to 70 kg: Start at 0.5 mg/kg/day, increase after 3 days to target dose of 1.2 mg/kg/day
- For children over 70 kg: Start at 40 mg/day, increase after 3 days to target dose of 80 mg/day
- Maximum dose: 1.4 mg/kg/day or 100 mg (whichever is less) 3
Behavioral Interventions
- Parent-administered behavior therapy: Training parents in behavior management techniques
- Teacher-administered behavior therapy: Classroom behavior management strategies
- Educational interventions: May include:
- Classroom accommodations
- Organizational skills training
- Time management strategies
- Special education services when appropriate 1
Important Considerations
Medication Management
- Titrate medication doses to achieve maximum benefit with minimum side effects 1
- Regular monitoring for side effects including:
- Cardiovascular effects
- Weight changes
- Sleep disturbances
- Development of tics or psychiatric symptoms 1
- Follow-up within 2-4 weeks after medication adjustments 1
Comorbid Conditions
- Screen for and address comorbid conditions that may complicate treatment:
- Emotional/behavioral disorders (anxiety, depression, oppositional defiant disorder)
- Developmental disorders (learning disabilities, language disorders)
- Physical conditions (tics, sleep apnea) 1
Long-term Management
- ADHD is a chronic condition requiring ongoing management 1
- Periodically reevaluate the need for continued medication 3
- Maintain communication between healthcare providers, parents, and school personnel 4
Common Pitfalls to Avoid
Treating preschoolers with medication as first-line therapy - Behavioral interventions should be tried first in this age group 1
Failing to screen for comorbid conditions - These can complicate treatment and may require additional interventions 1
Inadequate medication monitoring - Regular follow-up is essential to assess effectiveness and side effects 1
Not involving schools in treatment planning - Educational interventions and teacher feedback are crucial components of effective ADHD management 1, 4
Discontinuing treatment prematurely - Many children require long-term management to maintain improvements in functioning 3, 5