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Mark Hutten, M.A.
Re: Treatment for Attention Deficit Hyperactivity Disorder (ADHD)

How is ADHD treated?

Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments
include medication, various types of psychotherapy, education or training, or a combination of treatments.

Medications—

The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to
treat ADHD with a medication considered a stimulant, it actually has a calming effect on kids with ADHD. Many types of
stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than
stimulants. For many kids, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus,
work, and learn. Medication also may improve physical coordination.

However, a one-size-fits-all approach does not apply for all kids with ADHD. What works for one youngster might not
work for another. One youngster might have side effects with a certain medication, while another youngster may not.
Sometimes several different medications or dosages must be tried before finding one that works for a particular
youngster. Any youngster taking medications must be monitored closely and carefully by caregivers and physicians.

Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also
come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the
same, but it is released differently in the body. Long-acting or extended release forms often allow a youngster to take
the medication just once a day before school, so they don't have to make a daily trip to the school nurse for another
dose. Moms and dads and physicians should decide together which medication is best for the youngster and whether
the youngster needs medication only for school hours or for evenings and weekends, too.
What are the side effects of stimulant medications?

The most commonly reported side effects are decreased
appetite, sleep problems, anxiety, and irritability. Some
kids also report mild stomachaches or headaches. Most
side effects are minor and disappear over time or if the
dosage level is lowered:

•        Decreased appetite. Be sure your youngster eats
healthy meals. If this side effect does not go away, talk
to your youngster's physician. Also talk to the physician
if you have concerns about your youngster's growth or
weight gain while he or she is taking this medication.

•        Less common side effects. A few kids develop
sudden, repetitive movements or sounds called tics.
Are stimulant medications safe?

Under medical supervision, stimulant medications are considered safe. Stimulants do not make kids with ADHD feel
high, although some kids report feeling slightly different or "funny." Although some moms and dads worry that stimulant
medications may lead to substance abuse or dependence, there is little evidence of this.

FDA warning on possible rare side effects:

In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain
information about the risks associated with the medications. The guides must alert patients that the medications may
lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when
a review of data found that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart
attacks, and/or sudden death when taking the medications.

The review also found a slight increased risk, about 1 in 1,000, for medication-related psychiatric problems, such as
hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood),
even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD
include an initial health history, including family history, and examination for existing cardiovascular and psychiatric
problems.

One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that kids and
teenagers who take atomoxetine are more likely to have suicidal thoughts than kids and teenagers with ADHD who do
not take it. If your youngster is taking atomoxetine, watch his or her behavior carefully. A youngster may develop
serious symptoms suddenly, so it is important to pay attention to your youngster's behavior every day. Ask other
people who spend a lot of time with your youngster to tell you if they notice changes in your youngster's behavior. Call
a physician right away if your youngster shows any unusual behavior. While taking atomoxetine, your youngster should
see a physician often, especially at the beginning of treatment, and be sure that your youngster keeps all
appointments with his or her physician.

Do medications cure ADHD?

Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications
can help a youngster pay attention and complete schoolwork. It is not clear, however, whether medications can help
kids learn or improve their academic skills. Adding behavioral therapy, counseling, and practical support can help kids
with ADHD and their families to better cope with everyday problems. Research funded by the National Institute of
Mental Health (NIMH) has shown that medication works best when treatment is regularly monitored by the prescribing
physician and the dose is adjusted based on the youngster's needs.12
These tics may or may not be noticeable. Changing the
medication dosage may make tics go away. Some kids
also may have a personality change, such as appearing
"flat" or without emotion. Talk with your youngster's
physician if you see any of these side effects.

•        Sleep problems. If a youngster cannot fall asleep,
the physician may prescribe a lower dose of the
medication or a shorter-acting form. The physician might
also suggest giving the medication earlier in the day, or
stopping the afternoon or evening dose. Adding a
prescription for a low dose of an antidepressant or a
blood pressure medication called clonidine sometimes
helps with sleep problems. A consistent sleep routine
that includes relaxing elements like warm milk, soft
music, or quiet activities in dim light, may also help.