Options for managing ADHD

Treatment for attention deficit hyperactivity disorder (ADHD) involves the following areas:

ADHD medications may come immediately to mind. These can be life changing, if used appropriately, but they are only a part of good management in ADHD. There are four other key ways to making progress.

Lifestyle change is vital in children and adults. It begins with understanding the problem better through reading, listening to educational tapes or attending educational groups, and then establishing new habits including routines, taking on one task at a time, and learning to hold the 'mental committee meeting'.

Dietary modification in children. This means reducing amines, salicylates and glutamates, and differing reports claim it helps between about 5% and 20% of ADHD sufferers, mainly those under six years. While diet modification is a complex area, a summary of this and alternative treatments is available online at the ADHD support groups at the bottom of this page.

Importantly, beware of extreme and faddish diets. Life is hard enough for such children, without making them miserable on weird diets. (The most significant 'dietary' problem in young adults is marijuana, with alcohol a close second. These, and caffeine, are widely used for self-medication.)

Educational help. This is most effective on a one-to-one basis. Specific Learning Disabilities Federation (SPELD) tutors are great for dyslexic problems. Understanding and working with the best learning styles, whether visual, auditory or hands-on, is a huge help.

Support. Family and friends who encourage but do not take over are a big asset. Voluntary organisations like the NZ ADHD Association, ADDvocate and Teenadders all do a brilliant job. Psychotherapy of all kinds has not been shown in studies to make a significant difference, and can even get in the way of good family support.

Medications for ADHD

Methylphenidate (prescribed as Concerta, Ritalin, Rubifen) and dexamphetamine have been around since 1954 and 1937, respectively. They are equally effective and each suits a different 80% of ADHD patients.

Methylphenidate has been the first choice drug in New Zealand. It has an excellent record of safety and, properly used, it is not addictive. It raises the dopamine level and so improves concentration. Side effects are usually minor and brief. Despite popular rumour, physical growth is not affected long term.

The dose required varies according to the child's response; however, it should be remembered that the goal is optimal concentration and learning, and this may be achieved at a lower dose than that needed to result in compliant behaviour. The slow-release forms of methylphenidate, which last six to 12 hours, help avoid the need for a lunchtime (at school) dose. However, they do not suit everyone.

Antidepressants of various kinds are also used in ADHD but they have much less pronounced effect on concentration. Clonidine (a drug usually used to treat high blood pressure) does nothing for attention but may help to contain really difficult behaviour. Risperidone (an antipsychotic drug) is becoming more widely used for the same purpose. All of these can be taken with methylphenidate - your doctor can explain how best to take them and what to watch out for in terms of side effects.

None of the numerous so-called natural products for treating ADHD have been shown in randomised controlled trials to provide a better result than placebo (dummy medication).

Stimulant abuse

Abuse of stimulant drugs is a difficult issue. The medical and pharmacy professions prevent it as far as possible by regulating the supply and through close co-operation, while maintaining drug availability for the patients who need it. This is for the benefit of everyone - the vast majority of ADHD patients do not abuse the medications but the safety measures need to be in place for the few who might.

Having ADHD does predispose that person to substance abuse, so there will be a number of people with both ADHD and a substance abuse problem. There is a risk such ADHD patients will be denied stimulant treatment, but this may be avoidable if the patient is motivated to deal with the abuse and there is good medical, family and community support.

Drugs in development and medications available outside of New Zealand

New potential drugs are being tested but it will be some time before they have the proven record of effectiveness and safety of the currently available medications. The most effective way to manage this common and potentially damaging problem is good teamwork, which includes a motivated patient.

See also: ADHD - what is ADHD? and: ADHD - how is ADHD diagnosed?

Recommended further reading:

• Understanding ADHD by Dr Christopher Green
• The Hidden Handicap by Dr Gordon Serfontein
• You and Your ADD Child by Ian Wallace
• ADD in Adults by Dr Gordon Serfontein
• Driven to Distraction by Drs Hallowell and Ratey
• Answers to Distraction by Drs Hallowell and Ratey
  (All of these are available from good bookshops or the library.)

Your own family doctor will be able to provide help with ADHD.

This article was written by Dr Tony Hanne, an Auckland GP who specialises in ADHD. Originally published in Pharmacy Today newspaper. Copyright 2003 UBM Medica (NZ) Ltd.