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ADHD Treatment in Children & Teens

ADHD Treatment in Children & Teens

Learning your child has attention deficit hyperactivity disorder (ADHD) can spark many emotions and reactions: anxiety, confusion, overwhelm, self-blame. You might fear the worst: Your child will inevitably get bad grades, get suspended, get bullied, and abuse drugs.

But while ADHD does create various challenges, there are also various highly effective, evidence-based ways to manage it—ways that help children and teens succeed in all areas of their lives. In other words, while difficult, ADHD doesn’t have to define your child or their future.

In general, the best treatment is a combination approach with medication and behavior therapy (with one exception). ADHD is complex, so addressing it with pharmacological and psychosocial interventions ensures that your child will reap the greatest benefits. Medication helps to reduce impulsive behavior and hyperactivity, and to enhance focus, helping kids and teens to learn, study, and perform better at school and at work. Behavior therapy helps to strengthen positive behaviors and eliminate problematic ones. School interventions also are important.

In general, it’s critical for parents to take an active, collaborative approach with your child’s treatment team. You are your child’s best advocate. This article focuses on treatment strategies for children and teens; this article describes ADHD treatment for adults.

Medication

According to the American Academy of Pediatrics (AAP), for young kids, under 6 years old, medication is not the first line treatment. That’s because young kids tend to have more side effects from ADHD medication than older kids (see more information in the section on psychosocial treatment.)

However, a doctor might prescribe medication if behavior therapy doesn’t provide significant improvement, and your child still has moderate to severe symptoms. Your child’s doctor might start with methylphenidate (such as Ritalin or Concerta), which is a class of stimulant medication.

It’s recommended to start with the lowest dose, and gradually increase the medication until the right dose is found. It’s also recommended that preschoolers stop taking their medication after 6 months to reassess symptoms and determine whether it’s necessary to keep taking the medication.

For kids 6 to 11 years old, stimulants are typically the first to be prescribed because they’re highly effective, safe, and fast acting. About 70 to 80 percent of kids with ADHD have fewer symptoms with stimulants.

Your child might take methylphenidate or another class of stimulants: amphetamines, which includes the medications Adderall, Dexedrine, Dynavel XR, Adzenys XR, and Eveko. These medications usually start working within 30 to 45 minutes, and depending on the specific drug, will wear off after 4, 8, or 12 hours. However, these are just estimates. For instance, for some kids taking a short-acting stimulant, effects might wear off in 3 hours instead of 4.

In addition to stimulant pills, Daytrana is a skin patch that contains methylphenidate, and has been approved by the U.S. Food and Drug Administration (FDA) for 6- to 17-year-olds. It works for up to 12 hours. It does carry a warning of chemical leukoderma, a permanent loss of skin color.

The side effects of stimulants include decreased appetite, sleep problems, stomachache, headaches, anger, irritability, and tics.

Some of these side effects, such as decreased appetite, may go away within several weeks. Other side effects can be reduced by changing the dose or the time the medication is given, so it’s vital to talk to your child’s doctor if they experience any of these side effects.

Some parents are concerned about stimulants leading to substance abuse in teens with ADHD (in part because of news stories about students without ADHD abusing stimulants). However, stimulants don’t lead to substance abuse. Research has found that ADHD itself increases the risk for substance use (along with other risky behaviors), but substance use tends to decline when ADHD is treated.

The AAP noted that there’s less strong but sufficient evidence for non-stimulant medications: atomoxetine (Strattera), guanfacine extended release (Intuniv), and clonidine extended release (Kapvay). Your child’s doctor will prescribe a non-stimulant if stimulants didn’t work; your child can’t tolerate the side effects; or your child has a heart condition, seizure disorder, narrow-angle glaucoma, or takes inhaled steroids for asthma. Non-stimulants take longer to work, but they also last longer (up to 24 hours).

Strattera may cause decreased appetite, stomachaches, nausea, vomiting, dizziness, fatigue, and mood swings. As with stimulants, some side effects dissipate over time, and others can be reduced.

Intuniv is for kids ages 6 to 12. One of the most bothersome side effects for some kids is sedation. Other side effects include nausea, stomach pain, dizziness, low blood pressure, irritability, vomiting, and slow heart rate.

Kapvay, which is mainly used to treat hypertension, reduces hyperactivity, impulsivity, aggression, sleep issues, and anxiety. But it doesn’t seem to work on inattention. Kapvay doesn’t suppress appetite. Its side effects include: sedation, tiredness, irritability, mood changes, increased body temperature, and ear pain.

Because children change as they grow—and their environments and the demands they face evolve as well—it is important for families and the treating physician to maintain an open line of communication. It’s also important to talk with your child’s doctor if you’re concerned about side effects, or the medication not working. Avoid abruptly stopping a medication without first discussing it with your child’s doctor.

If you’d like your child to stop taking medication, or they’re a teen and express a desire to stop, consult your doctor about doing a trial period. Together you can come up with a specific plan and specific goals, which might include ramping up time with tutors and ramping up check-ins with their teachers. Also, include signs that indicate it might be time to return to medication, such as declining grades.

Psychosocial Treatment

Psychosocial treatments are imperative for all kids with ADHD. It’s the other piece of the ADHD puzzle, in combination with medication, because medication stops working when you stop taking it, but the skills, strategies, and tools presented in psychosocial treatments stay with you and your child. Again, for children under 6 years old, behavior therapy is the first line treatment.

According to the Society of Clinical Child and Adolescent Psychology, the following treatments are considered to “work well” in kids and teens with ADHD:

  • Behavioral parent training (BPT) teaches parents the skills and strategies to reinforce positive behaviors in their children, discourage negative behaviors, and to strengthen their interactions and relationship with their child. You’ll learn how to closely observe your child’s behavior, and increase their positive behaviors by using praise, positive attention, and reward systems. To discourage negative behavior, you’ll learn how to use consistent consequences (e.g., time-outs), and ignore minor bad behavior. This is especially critical because ADHD tends to co-occur with oppositional defiant disorder (ODD), which is characterized by frequent, explosive tantrums and disobedient, hostile behavior. Research has found that these behavioral parent training programs are effective: Parent-Child Interaction Therapy (PCIT), Incredible Years Parent Program, Triple P – Positive Parenting Program, and New Forest Parenting Programme (specifically created for ADHD). You can learn more about how to set up a behavior management plan for a child with ADHD.
  • Behavioral classroom management (BCM) involves your child’s teacher supporting their positive behavior (while minimizing negative behavior) and increasing your child’s academic engagement and performance in school. A common and effective intervention is the daily report card (DRC). Your child’s teacher identifies the target behaviors for the classroom (e.g., completes homework on time, doesn’t touch anyone without their permission). Every day, the teacher completes the card, which lists the positive behaviors your child is working on, along with a rating scale. At home, you provide rewards (e.g., playing a game) or consequences (removing a video game) based on the number of points your child earns each day. As your child’s behavior improves or new issues develop, their teacher will adjust the target behavior.
  • Behavioral peer interventions (BPI) typically involve one or more of the child’s classmates who offer a variety of support. For instance, in classroom-wide tutoring, students are divided into small learning groups, which consist of a high-performing student, an average-performing student, and a low-performing student. The goal is for each team to help each other understand and learn the material. This 2013 brochure includes several other examples.
  • Organizational skills training (OST) teaches kids what it means to be organized, along with concrete skills to organize their books and backpacks, use checklists and a planner, and manage their homework and their time. This is vital because procrastinating and not being able to plan, prioritize, and organize tasks follows kids into adolescence and then into adulthood. Even gifted students who lack organizational skills experience poorer academic performance. Parents also are involved in these interventions. You’ll prompt, praise, and reward your child for learning and practicing these skills in different contexts.

If your child continues to be defiant into their teenage years, Collaborative Problem Solving (CPS) might be helpful. It’s a program developed by Ross W. Greene, PhD., an associate professor of psychiatry at Harvard Medical School, which postulates that defiant kids with ADHD aren’t being malicious or manipulative. Rather, they lack emotional and behavioral skills, which CPS aims to teach. CPS consists of three steps: identifying and understanding your child’s concerns about a problem (e.g., completing homework); identifying your concerns about that problem; and together brainstorming a plan of action that both of you are satisfied with.

Learn more: Comprehensive Treatment of Childhood ADHD

School Services and Accommodations

Your child may qualify for certain services and accommodations in school, which are provided by two federal laws: the Individuals with Disabilities Education Act (called IDEA) and Section 504 of the Rehabilitation Act of 1973 (called Section 504).

Students who qualify for services under IDEA receive a written Individualized Education Plan (IEP) after they’ve been evaluated by a team of different professionals, which includes your child’s teacher and a school psychologist. The IEP consists of specific goals for your child’s learning and academic performance, along with details about the services that’ll be provided, and how progress will be measured. Parents participate in creating the IEP with their child’s teacher, a school psychologist, and other school professionals.

Section 504 is a civil rights statute that declares kids with disabilities cannot be discriminated against, and provides accommodations to help students learn and succeed in school. For instance, your child might be allowed to record a lesson instead of taking notes, have access to a computer, have more time to complete a test, and work in a quiet environment without distractions.

Students with a 504 plan still participate in state exams, and learn at the same level as students without disabilities. The 504 plan also is created by a team of people, and is typically written down.

You can learn more in this PDF chart, which lays out the step-by-step special education process. Also, learn more about your child’s educational rights and how you can help them succeed in school in this piece on IEPs, and in this series of articles on CHADD.org.

Tips for Parents

  • Become an expert in ADHD. Learn everything you can about ADHD in kids and teens, including the neurobiological underpinnings of ADHD. Become a keen observer of your child, paying attention to their specific symptoms and their strengths and weaknesses. Also, learn specific ways you can support your child, including their educational rights, and helpful steps to take a home. For instance, the organization CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) offers a variety of courses for parents in different formats, online or in person. They also host an annual conference that anyone can attend.
  • Get evaluated (and treated) yourself. ADHD tends to run in families. Often when a child gets diagnosed with ADHD, one of their parents realizes they have ADHD, too. Get a comprehensive assessment from a mental health professional, and, if you have ADHD, find effective ways to treat and manage it. This might include working with a therapist and/or ADHD coach.
  • Become an effective case manager and team captain: CHADD stresses the importance of keeping all your child’s records, including copies of their report cards, teacher notes, disciplinary reports, and evaluations, along with information about their treatments and the professionals they’ve worked with. CHADD also recommends thinking of yourself as a team captain in charge of a team that fully understands and appreciates your child’s ADHD. For instance, during school meetings about your child, you might present input from other professionals, such as your child’s psychiatrist or psychologist.
  • Talk to your child about their ADHD. Let your child know that they have ADHD, because keeping the diagnosis a secret implies that there’s something to be ashamed or embarrassed about. Start the conversation in a positive way, emphasizing that your child’s brain works really fast, faster than most people’s. Tell your child they’re not alone in having ADHD, and that they can capitalize on their boundless energy and new ideas in cool ways. You can learn more about tips for talking to your child in this Psych Central piece, and read an example in this article on ADDitude.
  • Create systems and structure. The process will vary depending on your child’s age. For instance, when your kids are younger, you can set the routine, which includes the same schedule for the mornings—washing their face, getting dressed, eating breakfast, brushing their teeth—afternoons—playing outside, eating a snack, completing homework—and evenings—eating dinner, cleaning up, taking a bath, reading a book, saying prayer, and getting into bed. Have a home for all your child’s things, including backpacks, shoes, and toys. Teach them to put these items in their proper place. Get creative with different ways to prompt your kids—such as using a laminated piece of paper with pictures, or a system with a dry-erase board and magnets. When your kids are older, you can come up with a structured plan together.
  • Observe your child to see how they work best. For instance, your child might focus best on their homework when they’re listening to music or to white noise, or when they’re moving around. Or they might focus best after playing outside for 30 minutes. Try to honor this as much as possible.
  • Communicate clearly. It’s hard for kids with ADHD to listen to instructions, particularly instructions that involve multiple steps. It’s also hard because distractions are aplenty, whether it’s the TV, or the water running, or the thoughts swirling inside their brains. When talking to your child, turn off all technology, get closer, make eye contact, and give them simple, specific, clear, concise directions.

Learn more: How to Talk To Your Kids about ADHD

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

ADHD Information for Teens. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Retrieved from https://chadd.org/for-parents/adhd-information-for-teens/.

ADHD Treatment Recommendations. (2018, September 18). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ncbddd/adhd/guidelines.html.

Behavior therapy. (2017, August 3). Society of Clinical Child & Adolescent Psychology. Retrieved from https://effectivechildtherapy.org/therapies/what-is-behavior-therapy/.

Behavior therapy for young children with ADHD: Finding a therapist. National Center on Birth Defects and Developmental Disabilities. Retrieved from https://www.cdc.gov/ncbddd/adhd/documents/behavior-therapy-finding-a-therapist.pdf.

Bikic, A., Reichow, B., McCauley, S.A., Ibrahim, K., Sukhodolsky, D.G. (2017). Meta-analysis of organizational skills interventions for children and adolescents with Attention-Deficit/Hyperactivity Disorder. Clinical Psychology Review, 52, 108-123.

Chorniy, A., Kitashima, L. (2016). Sex, drugs, and ADHD: The effects of ADHD pharmacological treatment on teens’ risky behaviors. Labour Economics, 43, 87-105.

Treatment of ADHD. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ncbddd/adhd/treatment.html.

 


Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.

APA Reference
Tartakovsky, M. (2019). ADHD Treatment in Children & Teens. Psych Central. Retrieved on May 24, 2019, from https://psychcentral.com/childhood-adhd/adhd-treatment-in-children-teens/
Scientifically Reviewed
Last updated: 7 May 2019
Last reviewed: By a member of our scientific advisory board on 7 May 2019
Published on Psych Central.com. All rights reserved.