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Following a primary diagnosis of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), in a child, adolescent or adult, clinicians have a wide range of non-pharmacological and pharmacological treatment options available to them.1-4

Treatment of child, adolescent and adult ADHD

eLearning module: Treatment of child, adolescent and adult ADHD

Guidelines

Evidence-based and consensus-driven guidelines for the treatment of ADHD have become an important framework for consolidating practice across countries and helping to improve the quality of care.1-4

There are multiple guidelines available to guide clinicians working in the field of ADHD in children, adolescents, and adults, and different guidelines may also have different recommendations about specific treatment approaches.1-4 These guidelines have been continually updated as new evidence comes to light and new therapeutics are developed, including updates to the NICE, CADDRA and German guidelines in 2018 and the Spanish guidelines in 2017.1-4

Optimal management of ADHD

The aim of ‘optimal management of ADHD’ could be described as where an individual patient’s level of symptoms and functional impairment are reduced, quality of life is improved and symptom benefits outweigh any unwanted adverse events.1,5,6

This description is supported by European and International guidelines for ADHD and by current literature.1,5,6

Figure: The ‘optimal management of ADHD’ cycle. Figure developed from multiple sources.1,2,5-10

The ‘Optimal management of ADHD’ cycle

Transition in ADHD

The journey through adolescence into adulthood is a time of significant physical, psychological and social change. During this period, adolescents may become lost in the system between child and adult mental health services, and may have nobody to ensure attendance.11 There is a clear need for a more structured approach to transition protocols.12-14

Non-pharmacological therapy

Non-pharmacological therapies for ADHD may involve behavioural, psychological, social, educational and lifestyle interventions.2,5,15-19

Figure: Non-pharmacological therapies. Figure developed from multiple sources.2,5,15-19

A list of non-pharmacological therapies for ADHD: behavioural therapy, psychoeducation plus excercise and diet

Pharmacological therapy

Pharmacological interventions are recommended by clinical guidelines for ADHD where required and as part of a comprehensive multimodal treatment plan that includes non-pharmacological therapies and is adapted to the specific needs and preferences of the patient.1-4

Available classes of pharmacological treatments for ADHD include:20-34

Stimulants

  • Methylphenidate
  • Amfetamine.

Non-stimulants

  • Atomoxetine
  • Guanfacine.

 

  1. Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Fourth Edition. Toronto, ON; CADDRA, 2018.
  2. NICE guideline 2018. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng87. Accessed February 2019.
  3. Banaschewski T, Hohmann S, Millenet S. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter. DGKJP, DGPPN and DGSPJ German guidelines. 2018.
  4. Guías de Práctica Clínica en el SNS. Grupo de trabajo de la Guía de Práctica Clínica sobre las Intervenciones Terapéuticas en el Trastorno por Déficit de Atención con Hiperactividad (TDAH). 2017.
  5. Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
  6. Remschmidt H, Global ADHD Working Group. Global consensus on ADHD/HKD. Eur Child Adolesc Psychiatry 2005; 14: 127-137.
  7. Kooij SJJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
  8. Bolea-Alamañac B, Nutt DJ, Adamou M, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28: 179-203.
  9. Hodgkins P, Dittmann RW, Sorooshian S, et al. Individual treatment response in attention-deficit/hyperactivity disorder: broadening perspectives and improving assessments. Expert Rev Neurother 2013; 13: 425-433.
  10. Scottish Intercollegiate Guidelines Network (SIGN). Management of attention deficit and hyperkinetic disorders in children and young people. 2009. Available at: https://www.sign.ac.uk/assets/sign112.pdf. Accessed February 2019.
  11. Lamb C, Hall D, Kelvin R, et al. Working at the CAMHS/adult interface: good practice guidance for the provision of psychiatric services to adolescents/young adults. A joint paper from the Interfaculty working group of the Child and Adolescent Faculty and the General and Community Faculty of the Royal College of Psychiatrists. 2008.
  12. Signorini G, Singh SP, Boricevic-Marsanic V, et al. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4: 715-724.
  13. National Institute for Health and Care Excellence. Transition from children’s to adults’ services for young people using health or social care services. 2017. Available at: https://www.nice.org.uk/guidance/ng43. Accessed February 2019.
  14. Singh SP, Paul M, Ford T, et al. Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. Br J Psychiatry 2010; 197: 305-312.
  15. Daley D, van der Oord S, Ferrin M, et al. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry 2014; 53: 835-847.
  16. Steiner NJ, Frenette EC, Rene KM, et al. In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial. Pediatrics 2014; 133: 483-492.
  17. Meisel V, Servera M, Garcia-Banda G, et al. Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up. Biol Psychol 2013; 94: 12-21.
  18. Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 2013; 170: 275-289.
  19. Cairncross M, Miller CJ. The effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. J Atten Disord 2016; Epub ahead of print.
  20. Purdue Pharma. Biphentin Product Monograph. Last updated April 2017.
  21. Novartis Pharmaceuticals Corporation. Focalin XR US Prescribing Information. Last updated January 2017.
  22. Shire Pharmaceuticals Ltd. Elvanse Adult Summary of Product Characteristics. Last updated November 2017.
  23. Sandoz Ltd. Matoride XL Summary of Product Characteristics. Last updated April 2017.
  24. Shire Pharmaceuticals Ltd. Intuniv Summary of Product Characteristics. Last updated February 2018.
  25. Flynn Pharma Ltd. Medikinet Summary of Product Characteristics. Last updated January 2017.
  26. Janssen Inc. Concerta XL Summary of Product Characteristics. Last updated July 2018.
  27. Shire Pharmaceuticals Ltd. Equasym XL Summary of Product Characteristics. Last updated June 2018.
  28. Auden Mckenzie (Pharma Division) Ltd. Dexamfetamine Sulphate Summary of Product Characteristics. Last updated April 2018.
  29. Paladin Labs Inc. Dexedrine Product Monograph. Last updated March 2016.
  30. Eli Lilly and Company Ltd. Strattera Summary of Product Characteristics. Last updated May 2015.
  31. Adderall XR Canadian Product Monograph. Last updated June 2017.
  32. Flynn Pharma Ltd. Amfexa Summary of Product Characteristics. Last updated July 2016.
  33. Shire Pharmaceuticals Ltd. Elvanse Summary of Product Characteristics. Last updated April 2018.
  34. Novartis Pharmaceuticals UK Ltd. Ritalin Summary of Product Characteristics. Last updated April 2018.
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