Attention deficit hyperactivity disorder (ADHD) - Treatment 

Treating ADHD 

Treatment for attention deficit hyperactivity disorder (ADHD) can help relieve the symptoms and make the condition much less of a problem in day-to-day life.

ADHD can be treated using medication or therapy, but a combination of both is often best.

Treatment is usually arranged by a specialist, such as a paediatrician or psychiatrist, although the condition may be monitored by your GP.

Medication

There are five types of medication licensed for the treatment of ADHD:

• methylphenidate
• dexamfetamine
• lisdexamfetamine
• atomoxetine
• guanfacine

These medications aren't a permanent cure for ADHD, but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.

In the UK, all of these medications are licensed for use in children and teenagers. Atomoxetine is also licensed for use in adults who had symptoms of ADHD as children.

If you weren't diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are suitable for you.

If you or your child is prescribed one of these medications, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.

Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

Methylphenidate

Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

Methylphenidate can be used by teenagers and children with ADHD over the age of six. Although methylphenidate isn't licensed for use in adults, it may be taken under close supervision from your GP and specialist.

The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).

Common side effects of methylphenidate include:

• a small increase in blood pressure and heart rate
• loss of appetite, which can lead to weight loss or poor weight gain
• trouble sleeping
• headaches
• stomach aches
• mood swings

Dexamfetamine

Dexamfetamine is also a stimulant medication, which works in a similar way to methylphenidate by stimulating areas of the brain that play a part in controlling attention and behaviour.

Dexamfetamine can be used by teenagers and children with ADHD over the age of three. Although it's not licensed for use in adults, it may be taken under close supervision from your GP and specialist.

Dexamfetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.

Common side effects of dexamfetamine include:

• decreased appetite
• mood swings
• agitation and aggression
• dizziness
• headaches
• diarrhoea
• nausea and vomiting

Lisdexamfetamine

Lisdexamfetamine is a similar medication to dexamfetamine, and works in the same way.

It can be used by children with ADHD over the age of six if treatment with methylphenidate hasn't helped. You may continue to take it into adulthood if your doctor thinks you're benefitting from treatment.

Lisdexamfetamine comes in capsule form, which you or your child usually take once a day.

Common side effects of lisdexamfetamine include:

• decreased appetite, which can lead to weight loss or poor weight gain
• aggression
• drowsiness
• dizziness
• headaches
• diarrhoea
• nausea and vomiting

Atomoxetine

Atomoxetine works differently to other ADHD medications.

It's known as a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing the amount can aid concentration and help control impulses.

Atomoxetine can be used by teenagers and children over the age of six. It's also licensed for use in adults if symptoms of ADHD are confirmed.

Atomoxetine comes in capsule form, which you or your child usually take once or twice a day.

Common side effects of atomoxetine include:

• a small increase in blood pressure and heart rate
• nausea and vomiting
• stomach aches
• trouble sleeping
• dizziness
• headaches
• irritability

Atomoxetine has also been linked to some more serious side effects that it's important to look out for, including suicidal thoughts and liver damage.

If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.

Guanfacine

Guanfacine acts on part of the brain to improve attention and it also reduces blood pressure.

It's used for ADHD in teenagers and children if other medicines are unsuitable or ineffective.

Guanfacine is usually taken as a tablet once a day, in the morning or evening.

Common side effects include:

• tiredness or fatigue
• headache
• abdominal pain
• dry mouth

Therapy

As well as taking medication, different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.

Some of the therapies that may be used are outlined below.

Psychoeducation

Psychoeducation means that you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour therapy

Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.

If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour.

For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent training and education programmes

If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour.

You may also be offered parent training before your child is formally diagnosed with ADHD.

These programmes are usually arranged in groups of around 10-12 parents. A programme usually consists of 10-16 meetings, which each last up to two hours.

They aim to teach parents and carers about behaviour management (see above), while increasing confidence in your ability to help your child and improve your relationship.

Social skills training

Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. A CBT therapist would try to change how your child feels about a situation, which would in turn potentially change their behaviour.

CBT can be carried out with a therapist individually or in a group.

Other possible treatments

There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidence these work, and they shouldn't be attempted without medical advice.

Diet

People with ADHD should eat a healthy, balanced diet. Don't cut out foods before seeking medical advice.

Some people may notice a link between types of food and worsening ADHD symptoms. For example, sugar, food colourings and additives, and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerances to wheat or dairy products, which may add to their symptoms.

If this is the case, keep a diary of what you eat and drink, and what behaviour this causes. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements

Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial in people with ADHD, although the evidence supporting this is very limited.

It's advisable to talk to your GP before using any supplements, because some can react unpredictably with medication or make it less effective.

You should also remember that some supplements shouldn't be taken long term, as they can reach dangerous levels in your body.