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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 treatment.1-4

The main classes of available ADHD pharmacological treatments include:

Stimulants

  • Methylphenidate (e.g. Ritalin®,5 Medikinet®,6 Biphentin®,7 Concerta®,8 Equasym®,9 Focalin®,10 Matoride®11)
  • Amfetamine (e.g. Adderall®,12 Amfexa®,13 Dexedrine®,14,15 Elvanse®,16 Elvanse Adult®17).

Non-stimulants

  • Atomoxetine (Strattera®18)
  • Guanfacine (Intuniv®19).

The decision about which medication should be used to treat ADHD depends on a range of factors, including: presence of comorbidities; undesirable effects of the medication; individual compliance needs; potential for drug diversion; and the personal preference of patients and their caregivers.1-4

Are there difficult areas of the day when control of ADHD symptoms is particularly important for children and adolescents with ADHD, for example, early morning, late afternoon, weekends, at school? | Dr Robert Findling | Johns Hopkins University and Kennedy Krieger Institute, Baltimore, MD, USA


When choosing the most appropriate treatment for your patient with ADHD, what consideration do you give regarding the flexibility of dosing? | Professor Peter Hill | Independent Child and Adolescent Psychiatrist, London, UK


When choosing a treatment, how big a consideration are the ADHD patients’ comorbid conditions or comorbid symptoms?  How do you decide which symptoms to treat? | Professor Peter Hill | Independent Child and Adolescent Psychiatrist, London, UK


When choosing a treatment, how big a consideration are the ADHD patients’ comorbid conditions or comorbid symptoms? How do you decide which symptoms to treat? | Dr Robert Findling | Johns Hopkins University and Kennedy Krieger Institute, Baltimore, MD, USA


How does treating adults with ADHD differ from treating children and adolescents? | Dr Joel Young | Rochester Centre for Behavioral Medicine, Rochester, MI, USA


Are there difficult areas of the day when control of ADHD symptoms is particularly important for children and adolescents with ADHD? | Professor Peter Hill | Independent Child and Adolescent Psychiatrist, London, UK


Mode of action

The modes of action of pharmacological treatments for ADHD are not fully understood; however, agents such as methylphenidate, amfetamine, atomoxetine and guanfacine all appear to have distinct effects on dopamine and noradrenaline signalling pathways in the brain.20-53

Mechanisms of delivery

Pharmacological treatments for ADHD can be delivered by immediate-release54 or extended-release (multiple bead,9,55-57 osmotic-controlled release,58,59 prodrug16,17,60,61) systems.

Pharmacokinetics

Pharmacokinetic data are available for all simulant and non-stimulant preparations.5-7,9,10,12,13,16-19,57,62-73

Differential response to treatment

Evidence from crossover studies suggests that some people with ADHD may respond differently to different types of pharmacological treatment, and that particular treatments may be ineffective in some patients.74-77

Adherence to treatment

Adherence to ADHD medication is often suboptimal, which can negatively affect treatment outcomes.78,79

Psychoeducation and knowledge of a patient’s acceptance of their condition may be helpful in encouraging adherence to medication, particularly in adolescents.2

Effect size

In the absence of direct comparative trials, effect sizes are calculated to allow indirect comparisons of randomised, double-blind, placebo-controlled studies of ADHD medications, and provide data on the relative efficacy of each medication.80,81

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