ADD (ADHD)

Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD) – Treatment Options

Introduction
Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by persistent patterns of inattention, hyperactivity, and/or impulsivity that interfere with functioning or development. ADHD may present predominantly as inattentive type, hyperactive-impulsive type, or combined type. It commonly begins in childhood but may persist into adolescence and adulthood, affecting academic, occupational, and social functioning. Treatment combines behavioral, educational, and pharmacological strategies tailored to the patient’s age, severity, and comorbid conditions.

1. Behavioral and Psychosocial Interventions

• Behavioral therapy:

  • Parent training in behavior management techniques.

  • Classroom behavior interventions and structured routines.

• Cognitive-behavioral therapy (CBT):

  • Improves organization, time management, and coping skills in older children and adults.

• School-based interventions:

  • Individualized education plans (IEPs) or 504 accommodations (extra time, quiet settings for exams).

• Social skills training: For children with difficulties in peer interactions.

2. Pharmacological Therapy

• Stimulants (first-line):

  • Methylphenidate (short-, intermediate-, and long-acting formulations).

  • Amphetamine salts (dextroamphetamine, lisdexamfetamine).

  • Mechanism: Increase dopamine and norepinephrine availability, improving attention and reducing hyperactivity/impulsivity.

• Non-stimulants (alternative or adjunct):

  • Atomoxetine (selective norepinephrine reuptake inhibitor).

  • Guanfacine and clonidine (alpha-2 adrenergic agonists, often used in children with tics or sleep disturbances).

  • Bupropion (off-label, especially in adolescents/adults with comorbid depression).

• Dosing considerations:

  • Individualized titration to balance efficacy and side effects.

  • Monitoring for appetite suppression, insomnia, cardiovascular effects, or mood changes.

3. Lifestyle and Supportive Measures

• Structured daily routines to reduce distractions and enhance predictability.

• Regular physical activity to improve focus and reduce hyperactivity.

• Healthy diet and sleep hygiene to support brain function and mood stability.

• Parental education and family counseling to promote consistency and reduce stress.

4. Monitoring and Long-Term Care

• Regular follow-up: Monitor growth, weight, cardiovascular parameters, and academic progress in children.

• Medication review: Adjust based on efficacy and side effects.

• Transition planning: For adolescents moving into adulthood, ensuring continuity of care.

• Comorbidity management: Screening and treatment for learning disorders, anxiety, depression, oppositional defiant disorder, or substance misuse.

5. Multidisciplinary Care

• Pediatricians/psychiatrists/neurologists: For diagnosis, medication management, and follow-up.

• Psychologists/therapists: For behavioral therapy and CBT.

• Teachers and educational specialists: To support academic accommodations.

• Social workers/counselors: To assist with family and social support.