Best Treatment for ADHD in Children
For children with ADHD, the most effective treatment is a combination of FDA-approved medications and behavioral therapy, with specific approaches tailored by age group. 1
Treatment Recommendations by Age Group
Preschool Children (4-5 years)
- Evidence-based behavioral parent training and behavioral classroom interventions should be the first-line treatment for preschool-aged children 1
- Methylphenidate may be considered only if behavioral interventions don't provide significant improvement and there is moderate-to-severe continued functional impairment 1
- Lower starting doses and smaller dose increments are recommended due to slower metabolism of methylphenidate in this age group 1
Elementary and Middle School Children (6-11 years)
- FDA-approved medications for ADHD along with behavioral therapy (both parent training and classroom interventions) should be prescribed 1
- Stimulant medications have the strongest evidence base, followed by atomoxetine, extended-release guanfacine, and extended-release clonidine (in that order) 1
- Combined treatment offers greater improvements on academic and conduct measures, especially when ADHD is comorbid with anxiety or when the child lives in a lower socioeconomic environment 1
Adolescents (12-18 years)
- FDA-approved medications should be prescribed with the adolescent's assent 1
- Evidence-based training interventions and behavioral therapy should be encouraged alongside medication 1
- Special consideration should be given to medication coverage for symptom control while driving due to increased crash risk 1
- Monitoring for substance use and medication diversion is essential 1
Medication Considerations
- Stimulants (methylphenidate, lisdexamfetamine) have the largest effect sizes for reducing ADHD core symptoms 1
- Common adverse effects include decreased appetite, sleep disturbances, increased blood pressure/pulse, and headaches 1
- Non-stimulants (atomoxetine, guanfacine, clonidine) provide "around-the-clock" effects but have smaller effect sizes compared to stimulants 1
- Combined medication and behavioral therapy allows for lower stimulant dosages, potentially reducing adverse effects 1
Behavioral Interventions
- Parent training in behavior management teaches techniques to modify and shape child behavior 1
- Classroom interventions include preferred seating, modified work assignments, and test modifications 1
- Training interventions target skill development for organization of materials and time management 1
- School-based services may be provided through 504 Rehabilitation Act Plans or Individualized Education Programs (IEPs) 1
Evidence on Treatment Sequencing
- Recent research suggests that initiating treatment with behavioral intervention first may produce better outcomes than beginning with medication 2
- Adding medication secondary to initial behavior modification resulted in better outcomes than adding behavior modification to initial medication 2
- Parents who began treatment with behavioral parent training showed substantially better attendance than those assigned to receive training following medication 2
Important Considerations
- Family preference is essential in determining the treatment plan and enhancing adherence 1
- Psychosocial treatments that coordinate efforts at school and home enhance treatment effects 1
- Some non-medication treatments (mindfulness, cognitive training, diet modification, EEG biofeedback) have insufficient evidence to recommend them 1
- Regular monitoring of height, weight, blood pressure, and pulse is necessary for children on medication 1
Treatment for Special Populations
- For children with comorbid substance use disorders, non-stimulant medications that minimize abuse potential (atomoxetine, extended-release guanfacine, extended-release clonidine) may be considered 1
- For children with comorbid anxiety, combined treatment offers greater improvements than medication alone 1
- For children with comorbid tics/Tourette's disorder, non-stimulants may be a first-line option 1