Should give your child ADHD medication

ADHD> Treatment in Children

1. The most important things in a nutshell

ADHD * can be present in children if they have problems with their development or behavior, have difficulty concentrating, or are very restless and impulsive. Diagnosis by a specialist makes sense, since early and suitable therapies can promote the development of the child and have a positive effect on school and social life.

2. Diagnosis

ADHD symptoms in children are particularly hyperactivity, impulsiveness, and / or inattentiveness. In addition, relationships, productivity or participation (= being included in a group) are often impaired in several areas of life.
A diagnosis of ADHD should not be made before the age of 3 years. Even in preschool age, ADHD should only be diagnosed if symptoms are very severe. In general, the younger the child, the more difficult it is to make a diagnosis.
Detailed information on the implementation of the diagnostic measures, the disciplines involved and the symptoms that indicate ADHD can be found under ADHD> Causes and Diagnosis or in the ADHD Guide.

3. Treatment

When choosing a suitable therapy, doctors should respond to the wishes of the child and the parents and discuss the treatment options available together. These depend on the severity of the symptoms, the personality and environment of the child as well as possible comorbidities.

As a rule, ADHD is caused by a so-called multimodal therapy treated. For this purpose, a treatment plan is drawn up in which psychosocial and drug therapies are combined:

  • Education and advice (Psychoeducation) of the parents, the child / adolescent and the educator or the class teacher
  • psychotherapy, usually behavior therapy
  • Support in kindergarten / school to improve the situation in kindergarten / school
  • Medication
  • Neurofeedback from the age of 6 years, if this does not delay / prevent other more effective therapies
  • Elimination diet (Omission of certain foods) in consultation with a nutritionist and doctor / psychotherapist, if a connection between foods and the behavior of the child has been confirmed
  • Support in kindergarten / school to improve the situation in kindergarten / school

In the case of particularly severe forms of ADHD or side effects such as endangering oneself or others, (partially) inpatient therapies in clinics or rehabilitation facilities can also be considered.

3.1. Psychoeducation

Psychoeducation means in particular the education and counseling of the person concerned and his social environment. It is an important building block in the treatment of ADHD. Together with the doctor, an individual treatment concept is drawn up with the following content, among others:

  • Explanation of the origin of the disease and possible risk factors
  • Explanation and discussion of the various therapy options
  • Dealing with disease-specific impairments
  • Strengths and resources of the person concerned

The aim of psychoeducation is to promote understanding of the disease so that the consequences of the disease can be better dealt with. Comprehensive information and advice is important in order to better understand the symptoms, optimize parenting behavior and reduce behavioral problems.

Children are introduced to the development of the disorder in a playful way. In adults, education is often provided through theoretical, fact-based knowledge. At all ages, the knowledge is then related to practical situations in order to be able to apply it specifically in everyday life. This gives the person affected an idea of ​​how to deal with the negative effects of ADHD and how to positively influence the consequences of the disorder.

If the psychoeducation takes place in the form of one-on-one interviews, the individual situation and symptoms can be addressed in particular. In group discussions, on the other hand, the person concerned can benefit from the exchange of experiences with others.

3.1.1. Practical tip

The online project ADHSpedia offers comprehensive information on the subject of psychoeducation in ADHD at www.adhspedia.de> search term: "Psychoedukation".

3.2. psychotherapy

The aim of psychotherapy for ADHD is to improve emotional and psychological behavior disorders with the help of different psychological therapy approaches. The therapy should support coping with the illness and contribute to an improvement in self-esteem problems. Which form of psychotherapy is used depends on the individual case and is agreed with the psychotherapist.

3.3. Medication

Whether drugs are used in ADHD therapy depends, among other things, on the age of the child, the severity of the symptoms and the wishes of the child / parents.

No medication is generally prescribed for children under three years of age. In toddler and preschool age only if psychoeducation and psychosocial support do not help and with special caution. From school age onwards, drug therapy is usually recommended in the case of severe symptoms and severe impairments in the child.

Treatment with medication should only be carried out after a confirmed diagnosis and by a specialist / medical psychotherapist. Before starting drug therapy, physical and neurological examinations should be carried out and pulse, blood pressure, body weight and height should be checked. These data, the effectiveness of the drug and any side effects should be checked approximately every 6 months. eggn times a year a treatment-free time without medication to check if they are still needed.

When choosing the drug, for example, the following points should be considered:

  • Current approval status
  • Duration of action
  • possible side effects
  • Additional illnesses (e.g. tic disorders, epilepsy)
  • Social aspects (e.g. if the child has to take a short-acting drug at school as well)

In Germany, the following active ingredients are approved for pharmacotherapy for children: methylphenidate, atomoxetine, dexamphetamine, lisdexamfetamine and guanfacine.

3.3.1. Methylphenidate

Methylphenidate is a stimulant (= substance that stimulates / accelerates the activity of the nervous system). It is the longest tried drug for the treatment of ADHD and is used to improve concentration and performance in children with ADHD. Methylphenidate is subject to the Narcotics Act and the prescription is made on a separate prescription form. Methylphenidate can increase the tendency to become addicted to drugs and can be misused as a performance-enhancing agent.

ADHD is triggered, among other things, by a dysregulation of the messenger substances dopamine and norepinephrine. Dopamine and norepinephrine, together with other messenger substances, are involved in the communication between nerve cells. If a cell releases the messenger substances, they are taken up again by the neighboring nerve cell with a short delay and the cell is excited. In ADHD, these two messenger substances are passed on too quickly and are therefore permanently present at the site of action in too low a concentration. Methylphenidate inhibits the re-uptake of the messenger substances dopamine and noradrenaline in the neighboring nerve cells. The inhibition of reuptake allows the messenger substances to linger longer at the docking points of the nerve cells. In this way, the disturbed dopamine and norepinephrine balance can be balanced and the ADHD symptoms decrease.

3.3.2. Lisdexamfetamine

Lisdexamfetamine is also a narcotic and must be prescribed on a special prescription. This active ingredient can also be misused as a stimulant intoxicant. Compared to methylphenidate, the abuse potential is somewhat lower, as the effects develop more slowly and for a longer period of time.

The way lisdexamfetamine works is not fully understood. It is believed that the drug causes an increased release of norepinephrine and dopamine, which promotes concentration and performance.

3.3.3. Atomoxetine

Atomoxetine is not an anesthetic and therefore promotes dependency significantly less than, for example, methylphenidate. It is also less likely to abuse the drug compared to methylphenidate because atomoxetine is less euphoric and stimulant.

The active ingredient inhibits the re-uptake of the messenger substance noradrenaline in neighboring nerve cells in the brain. Thus the total concentration of the messenger substance increases. This hardly affects the dopamine balance (in contrast to taking methylphenidate and lisdexamfetamine).

3.3.4. Guanfacine

Guanfacine is mainly given when treatment with stimulants is out of the question (e.g. because of intolerance or a tendency to become addicted). The mechanism of action of guanfacine in connection with ADHD is very complex and not yet fully understood. The active ingredient helps reduce impulsiveness.

3.3.5. Dexamphetamine

Dexamphetamine is also a narcotic. The drug increases the effects of norepinephrine and dopamine, which among other things increases the ability to concentrate and improve performance.

3.4. Neurofeedback

Neurofeedback can help children with ADHD to sustainably improve their concentration and attention and to focus on one thing. With neurofeedback, children train specifically to regulate their brain activity by being connected to a computer via an EEG (electroencephalography = device for measuring electrical brain activity). By concentrating, you can control what is happening on the screen. You can choose between several options for screen animation (e.g. influencing the flight altitude of a bird or the speed of a rocket). By repeating this procedure several times, the brain function is supposed to be permanently and positively changed and the symptoms of ADHD are alleviated. There should be at least 25-30 sessions.

3.5. (Partial) inpatient rehabilitation for children and adolescents with ADHD

Partial inpatient or inpatient rehab should be considered if, in the case of severe disorders, temporary support outside the family and social environment promises success or if the family would like to take advantage of supportive offers together. In the case of inpatient rehabilitation (= cure), mother or father can be admitted as an inpatient for therapeutic reasons. The parent is considered to be the accompanying person.

In rehab, patients and their parents have the opportunity to achieve lasting changes in behavior and thus to reduce the psychosocial stress in the family. The aim of rehab is also to strengthen the parent-child relationship. Targeted exercises promote mutual understanding and the ability to resolve conflicts. School children with ADHD receive knowledge-preserving lessons in a rehab clinic, in which motivational learning techniques are in the foreground.

 

Below are the links to the general provisions of rehabilitation:

 

Addresses of rehabilitation clinics:

  • "Handbook of Rehabilitation and Provisioning Facilities" with 1,500 rehabilitation clinics. Appears annually and is available from doctors and advice centers.
  • www.rehakliniken.de (= contents of the manual for rehabilitation and preventive care facilities).
  • www.kurklinikverzeichnis.de.

4. Side diseases

In some cases, children are also affected by other disorders that can occur in connection with ADHD, for example:

  • Oppositional (= refusing) defiant behavior
  • Other conduct disorders
  • Tic disorders
  • Developmental disorders
  • Autism Spectrum Disorders

 

* For the sake of simplicity, ADHD is used as a collective term for ADS (attention deficit disorder) and ADHD (attention deficit and hyperactivity disorder).

5. Related links

Attention Deficit Disorder (ADD) and Attention Deficit and Hyperactivity Disorder (ADHD)

ADHD> disability

ADHD> Diet

ADHD> upbringing

ADHD> care

ADHD> school

ADHD> Sports and Recreation

ADHD> Vacation

ADHD> Causes and Diagnosis

ADHD> Housing