Evidence-based pharmacological treatment options for ADHD
To address the symptoms of Attention Deficit Hyperactivity Disorder (ADHD), caregivers are frequently advised to use pharmacological therapy. Let’s read and understand what are the proven pharmacological options in the management of ADHD…..
This review summarizes available pharmacological treatment options for ADHD in children and adolescents. Also, it identifies current issues in research and evidence gaps. In addition, it provides an overview of ongoing efforts to develop new medications for the treatment of ADHD in children and adolescents. Read the original article published by researchers Mechler and team
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, causing functional impairment
ADHD shows high persistence to adulthood
Approximately 2.5% of adults have ADHD
Approximately 5% of children and adolescents have ADHD
No difference across countries worldwide!
Deficits found in persons with ADHD are:
Inattention
Hyperactivity
Compulsivity
Visuospatial Memory
Working Memory
Inhibitory Control
Vigilance
Planning
Reward Regulation
Psychiatric Disorders – Conduct
Somatic Disorders – Obesity
Comorbidities – ASD
Current treatment guidelines for Persons with ADHD are ..
The treatment for ADHD has to be using a combination of multiple methods and interventions. Especially, the treatment also has to be mediated by various professionals including Physicians, Psychologists, Special Educators, Speech-Language Pathologists, and Counsellors.
However, various personal and environmental factors like age, the severity of symptoms, individual needs of the patient, and opinions of the caregiver also guide the rehabilitation process
LET’S UNDERSTAND WHAT ARE THE APPROVED MEDICATIONS FOR ADHD….
Basically, there are two kinds of drugs usually prescribed in the treatment of ADHD- Stimulants and Non- Stimulants
Stimulants
Work on Dopamine receptors in the brain
Fast Acting
Thereby, the child will feel the effects of the drug in the first 30-90 minutes
However, the drug leaves the system in 3-12 hours
Non- Stimulants
Work on Norepinephrine receptors in the brain
Slow acting
Hence, the child will feel the effects of the drug after a minimum period of 2-4 weeks
LET’S UNDERSTAND ABOUT ‘STIMULANT’ MEDICATIONS…..
What are the benefits of Stimulants?
In particular, research has proven that Stimulants help in reducing symptoms of ADHD in children and adolescents
In addition, these medicines also improve quality of life and reduce functional impairment in ADHD
Also, they reduce the risk of emergency admission to hospital for trauma, injuries, suicidal events, substance abuse, criminality etc in ADHD
Short term effects of these medicines are well established. However, Long term effects need to be studied further.
What are some risks associated with stimulants?
Decreased appetite
Sleep disturbances
Increased blood pressure
Headaches
Irritability
Stomach pain
Reduction in height and weight gain
To summarize
Particularly, most adverse effects of these stimulants are mild or temporary.
These risks are generally acceptable
However, clinical decisions must be taken with caution considering other health factors
significantly, periodic examinations are required to determine the need for continuous medications. They should include medicine-free intervals.
Let’s understand about ‘Non- Stimulant’ Medications…..
Atoxomoxetine
Increases attention
Decreases hyperactivity & impulsivity
Risk:
Nausea
Vomiting
Fatigues
Decreases apetite
Clinical worsening
Unsual behaviour change
Suicidality
Clonidine
Improves attention, thought and working memory
Risks:
Fatigues
Irritability
Insomnia
Nightmares
Dry mouth
Sedation
Bradycardia
Syncope
Guanfacine
Improves attention, thought and working memory
Risks:
Fatigue
Irritability
Insomnia
Nightmares
In conclusion,
Presently, Non-Stimulants are recommended as a second-line treatment. The first line of treatment is stimulant medication.
However, Non-stimulants play an important role in ADHS and certain comorbid conditions like ADHS with Autism Spectrum Disorder
Therefore, consider Non stimulants as the first-line treatment for disruptive behaviours, tic disorder, Tourette’s syndrome and substance use disorders
Given this background information, what should be the line of treatment for persons with ADHD?
Firstly, pharmacological treatment of ADHD should always be part of an individualised multimodal treatment approach
The multimodal treatment approach generally includes- psychoeducation, pharmacological treatment, psychotherapeutic interventions and psychosocial interventions
In particular, Cases with Low and Moderate severity “CAN” be offered pharmacological treatment
Nonetheless, Cases with Severe symptoms “SHOULD” be offered pharmacological treatment
Also, use psycho-social and behavioural interventions for pre-schoolers.
Moreover, ‘severe’ cases require pharmacological interventions but with caution
Another key point is to use stimulants as first-line therapy and non-stimulants as second-line therapy.
Also, depending on changes in symptomatology, psychosocial situation and normal development, adjust and change the pharmacological treatment regimen.
In the same way, during the course of treatment, assess medication adherence regularly.
What are some other areas of research in Pharmacological Treatments for ADHD?
At this time, the comparable extent of systematic assessments for longer-term outcomes is not yet available
Comparison of ADHD medications head-to-head as well as in combination
Eventually, research should focus on improving medication adherence in children and adolescents with ADHD.
Moreover, relevant factors need evaluation to increase medication adherence as early as possible. If possible, before the initiation of pharmacological treatment. In addition, such factors include attitudes of patients and parents toward pharmacological treatment, a trustful physician-patient relationship, family support, and knowledge about the disorder and the intended medication.
Also, we need a systematic comparison of medicines to non-pharmacological treatment options (e.g., behavioural therapies, neurofeedback) as well as combined in order to reach conclusive recommendations for individualized treatment of ADHD.
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