What Is ADHD?
ADHD, a Neurodevelopmental Disorder
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a combination of three symptoms, the intensity and manifestation of which vary from one person to another:
attention deficit (inability to maintain attention, complete a task, frequent forgetfulness, etc.);
motor hyperactivity (constant restlessness, inability to stay still);
impulsivity (difficulty waiting, tendency to interrupt others' activities).
Depending on the child, one or two symptoms may predominate, but most often, all three symptoms are present simultaneously.
ADHD can only be considered if the symptoms:
appear during childhood, before the age of 12;
are persistent (more than 6 months);
have an impact on academic learning, social relationships, and quality of life, and constitute a real handicap for the child. How common is ADHD?
ADHD affects 5% of people under 18 and 3% of adults. ADHD present in children persists into adolescence and adulthood.
It appears that this disorder is twice as common in boys. However, it is likely underestimated in girls, in whom the symptoms are less visible. Indeed, girls, being less hyperactive, tend to have attention deficit disorder, which is harder to spot.
What medications are used to treat ADHD?
Stimulants
Although they don't cure ADHD, medications are more likely to improve symptoms of attention, impulsivity, and hyperactivity than other approaches.
Stimulants are the most commonly used medications to treat ADHD. They alleviate symptoms in about seven out of ten children (70%) with ADHD.
Stimulants work as follows:
When a person has ADHD, the pathways in the brain's frontal lobe, which are involved in attention, don't work as they should.
Stimulants increase dopamine, a chemical that helps activate brain pathways.
This increase in dopamine helps improve attention and reduce hyperactivity and impulsivity.
Stimulants have been used for a long time. Doctors understand how they work and know what to look for to ensure they are safe and effective.
Each of the three main stimulants contains a different active ingredient:
Methylphenidate (e.g., Ritalin, Biphentin, and Concerta)
Dextroamphetamine (dexedrine, dexedrine spansule, and Vyvanse)
Mixed amphetamine salts or MSA (Adderall XR)
All of these medications work in much the same way and have similar side effects.
They can be short-acting or long-acting. They share the same active ingredient, but their form (tablet, capsule) and the way they are released into the body are different. Your child's doctor will choose a medication based on your child's symptoms, other health problems, sleep habits, eating habits, and ability to swallow medication.
Stimulants are usually prescribed for a trial period (often three weeks) to see if they are suitable for your child. They are not habit-forming. They can be stopped if they don't work or if they have side effects that don't go away despite changing the dose or frequency.
Second-Line Medications
Other medications can be used to treat ADHD if stimulants are not effective or tolerated:
Atomoxetine (Strattera) is a long-acting non-stimulant that works throughout the day. Your child will need to take it for a while (up to two months) before knowing if it's effective.
Alpha-agonists such as clonidine (Dixarit, Catapres) and long-acting guanfacine (Intuniv XR) may be good choices for children with tics, marked impulsivity, or impulsive aggression. Atypical antipsychotics such as risperidone (Risperdal) are NOT RECOMMENDED for "uncomplicated" cases of ADHD because they don't really help with attention. They can be used in children with disruptive and aggressive behavior, but medical supervision (examination and blood tests) is required because they cause more side effects. They should only be used if other ADHD medications aren't effective.
Is medication right for my child?
If your child is under six years old, the preferred treatment is not medication. Your doctor will first recommend behavioral interventions.
If your child is six years old or older, your child's doctor should take the following steps before suggesting medication:
Review your child's medical history, including strategies that haven't worked. Perform a physical exam to check if there is any reason why your child should not take one of these medications.
Measure your child's height, weight, and vital signs (blood pressure and pulse). These can be checked at future appointments to ensure the medications are not causing a problem. No lab tests are necessary when your child is taking stimulants.
You or your child's teachers may be asked to complete questionnaires to determine which symptoms need to be treated and to monitor your child's response to the medication.