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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.1-6

Treatment of child, adolescent and adult ADHD

eLearning module: Treatment of child, adolescent and adult ADHD

Guidelines

Clinical guidelines are available to provide evidence-based recommendations for the management of ADHD to help guide appropriate and rational choices of treatment.1-6

These guidelines assist patients and their families or carers in making informed decisions about treatment options1-6; improve communication between clinicians, patients and families1-6; and set standards to assess the practice of healthcare professionals.1-6

International guidelines for the management of ADHD1-8

International guidelines for the management of ADHD

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.1,3,5

This description is supported by European and International guidelines for ADHD and by current literature.1,3,5

The ‘Optimal management of ADHD’ cycle1-6,9,10

The ‘Optimal management of ADHD’ cycle

Non-pharmacological therapy

Non-pharmacological therapies for ADHD may involve behavioural, psychological, social, educational and lifestyle interventions.3,4,11-14

Non-pharmacological therapies

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 as part of a comprehensive treatment programme (including a behavioural therapy component) if there is insufficient response to non-pharmacological therapy.1-6

Available classes of pharmacological treatments for ADHD include:15-29

Stimulants

  • Methylphenidate
  • Amfetamine.

Non-stimulants

  • Atomoxetine
  • Guanfacine.

 

  1. Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Toronto: CADDRA, 2011.
  2. Kooij SJ, 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.
  3. 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.
  4. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg72/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-975625063621. Last updated 2016. Accessed 05 January 2017.
  5. Remschmidt H. Global consensus on ADHD/HKD. Eur Child Adolesc Psychiatry 2005; 14: 127-137.
  6. 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.
  7. Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128: 1007-1022.
  8. Pliszka S. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46: 894-921.
  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. Available at: http://www.sign.ac.uk/pdf/sign112.pdf. Last updated 2009. Accessed 06 January 2017.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. Ritalin Summary of Product Characteristics. Novartis Pharmaceuticals UK Ltd. Last updated 05 May 2015.
  16. Medikinet Summary of Product Characteristics. Flynn Pharma Ltd. Last updated 10 September 2015.
  17. Equasym XL Summary of Product Characteristics. Shire Pharmaceuticals Ltd. Last updated 10 March 2014.
  18. Focalin XR US Prescribing Information. Novartis Pharmaceuticals. Last updated June 2015.
  19. Adderall XR Canadian Product Monograph. Last updated 23 September 2015.
  20. Dexamfetamine Sulphate Summary of Product Characteristics. Auden Mckenzie (Pharma Division) Ltd. Last updated 01 August 2016.
  21. Dexedrine Product Monograph. Paladin Labs Inc. Last updated 21 March 2016.
  22. Elvanse Summary of Product Characteristics. Shire Pharmaceuticals Ltd. Last updated 13 September 2016.
  23. Elvanse Adult Summary of Product Characteristics. Shire Pharmaceuticals Ltd. Last updated 13 June 2016.
  24. Strattera Summary of Product Characteristics. Eli Lilly and Company Ltd. Last updated 08 June 2015.
  25. Intuniv Summary of Product Characteristics. Last updated 10 December 2015.
  26. Concerta Product Monograph. Janssen Inc. Last updated 26 February 2015.
  27. Amfexa Summary of Product Characteristics. Flynn Pharma Ltd. Last updated 06 June 2016.
  28. Biphentin Product Monograph. Purdue Pharma LP. Last updated 10 June 2016.
  29. Matoride XL Summary of Product Characteristics. Sandoz Ltd. Last updated 02 December 2015.
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