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Attention deficit hyperactivity disorder (ADHD) is one of a number of behavioural and developmental disorders that affect young children. A child with ADHD has three main behavioural issues: inattention, impulsivity and overactivity. All young children have a limited attention span and sometimes do things without thinking. Only a few of these children have ADHD. Treatment for ADHD is complex and may include drug therapy, behavioural management, psychological counselling and family support groups. Treatment using medication is fast and - in many cases - effective, but research suggests that using a multifaceted approach ensures a greater success rate. Drugs target the brain's neurotransmitters Neurotransmitters are brain chemicals. There is some evidence to suggest that genetic abnormalities may prevent the child with ADHD from metabolising key neurotransmitters in normal ways. However, no specific brain defect has been found that could account for ADHD, which also means there is probably no single drug that can correct the problem. Stimulant drugs Stimulant drugs like dexamphetamine and methylphenidate (Ritalin) work by acting on the neurotransmitters that release the chemical dopamine. Greater amounts of dopamine help to curb the hyperactive and impulsive behaviours typical of the child with ADHD. The two main stimulant drugs used in the treatment of ADHD include dexamphetamine and methylphenidate (Ritalin). The calming effect of these medications is apparent within half an hour of taking them, and each dose lasts about three hours. Dexamphetamine and methylphenidate are different in their chemical makeup and effects, so a child may be more suited to one drug than the other. Some trials have found greater success in controlling ADHD symptoms if the child takes a combination of the two. Dosage schedules Any adjustments to medications should always be supervised by a doctor. Dosage and timing may need to be adjusted for the individual child to maximise control of ADHD symptoms while minimising potential side effects. For both dexamphetamine and methylphenidate, the dosage may be incrementally increased over three or four weeks, using half tablets if necessary. The medication may be discontinued if there is no improvement at the end of four weeks and the other drug can then be trialed in a similar way. If the medication works, its dose will gradually be increased as the child grows. Side effects of medication There have been few conclusive studies that document the long term side effects of drug treatment for ADHD. Some short term side effects of these stimulant drugs include: - Sleeping problems, such as insomnia
- Headache
- Drowsiness
- Anorexia
- Stomach pains
- Nausea
- Vomiting
- Dry mouth
- High blood pressure
- Tachycardia (increased heart rate)
- Psychosis
- Tourette's syndrome.
Follow up treatment Once medication has been established to relieve symptoms, the child should be monitored by their health professional every three months or so. The checkups include: - Thorough physical examination to check for side effects such as high blood pressure.
- Review of behaviours to see if the ADHD symptoms remain improved.
Other drugs Other drugs may be used in the treatment of ADHD, such as antidepressants and antipsychotics. However, these drugs are not as effective as stimulants and may have more serious side effects. The practice of multiple drug treatment, 'drug cocktails', should be avoided in very young children. Where to get help Your doctor
Paediatrician Things to remember Attention deficit hyperactivity disorder (ADHD) is one of a number of behavioural and developmental disorders that affect young children. Approximately one in every hundred Australian children is presently taking drugs to manage ADHD symptoms. The two main stimulant drugs used in the treatment of ADHD symptoms include dexamphetamine and methylphenidate ( Ritalin).
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