Current Research on the Treatment of ADHD
by Peter W. Welty, M.D., F.A.A.P.
August 23, 2004
The recent Journal of the American Academy of Child and Adolescent Psychiatry, July 2004 examined the current status of the treatment of ADHD.
Stimulant medication, such as Ritalin, Adderall, or Dexedrine still remains the most important cornerstone of ADHD management. ADHD medication should be considered for a child whose inattention, impulsivity, and hyperactivity are affecting their functioning at home. in school. and in the community. For mild cases, structure and limit setting may be enough. But the merits of stimulant medication for the treatment of ADHD have long been researched and established. In addition to improving inattention, impulsivity, and hyperactivity, stimulants have long been demonstrated to improve academic productivity and accuracy, as well as teacher, parent and peer interactions.
Although stimulants improve academic function, reading and arithmetic, they do not normalize an ADHD child’s performance or motivation. Academic problems in children with ADHD are likely to result from multiple factors that include inattention, poor organizational and study skills, poor working memory, and cognitive deficits. These negative experiences tend to reinforce low self-esteem.
Intensive and prolonged academic and social skills training, however, did not improve a child’s academic and social functioning better than carefully titrated stimulant medication alone. Prolonged (one-to-two years) and intensive parent skills training for ADHD children, also, did not appear to improve the quality of parenting skills, or parent-child interactions.
So, it appears that if one’s child has ADHD, the most important thing a parent can do is make sure that your child’s medication dose is optimal in terms of effects, side effects and duration of action. In other words, does the stimulant medication improve the child’s maladaptive inattention, impulsivity and hyperactivity? Does the medication allow one’s child to participate fully in the classroom? Can he play appropriately and cooperatively with peers? Is family, after school and evening home life improved with the stimulant medication?
And, in regard to side effects, are there problems with appetite, irritability, and rebound? If so, discuss this with your child’s physician. Considering the stimulant’s duration of action, be sure that your child’s stimulant medication lasts for enough time. Make sure that there are no rebound symptoms, especially if he is taking one of the shorter-acting preparations. The rebounds can occur around 10:00 a.m. to 12:00 noon for the morning dose and at 3:00 to 4:00 o’clock p.m. for the afternoon dose. Many children do very well on longer acting stimulant preparations which last anywhere from 6-12 hours. These new longer-acting preparations are invaluable for maintaining gains in ADHD functioning and for behavior at home and at school.
Since recent research has shown that adjunct treatments have limited sustained value in the outcome of ADHD children, a parent of such a child needs to make sure that their child’s medication is doing the most it can in addressing the child’s ADHD symptoms.
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