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Attention-deficit/hyperactivity disorder (ADHD) can be a serious and complex disorder requiring a comprehensive treatment approach

Attention-deficit/
hyperactivity disorder (ADHD) can be a serious and complex disorder requiring a comprehensive treatment approach

ADHD is a chronic condition with functional repercussions that increase in severity if left untreated as a child grows into adulthood.

In addition to disease comorbidity, having ADHD as a child increases future risk for:

Financial issues

Employment and economic status are generally lower in adults who had ADHD as children; this may be due to impulsivity in financial management and difficulties adjusting to a workplace environment.1

Motor vehicle accidents

Individuals who had ADHD as children are more likely to be in 2 or more car accidents and have a suspended driver’s license as adults.1

Substance use disorder

Alcohol and drug use both occur at higher rates in adolescents and adults with ADHD.1

Legal issues

One longitudinal study of a population with childhood ADHD found that nearly half had been arrested or served some time in jail.1

Because the consequences of untreated or insufficiently treated ADHD are significant, clinical guidelines recommend evidence-based multimodal treatment intervention as soon as a diagnosis of ADHD is made.2,3

  • This includes a combination of pharmacological and nonpharmacological therapies2,3
  • Treatment interventions vary based on the individual needs of the patient, as well as the patient’s age and severity of symptoms2

Pharmacologic treatment is a cornerstone of the ADHD treatment plan in pediatric patients

Pharmacologic treatment is a cornerstone of the ADHD treatment plan in pediatric patients

The American Academy of Pediatrics (AAP) recommends an FDA-approved medication for children and adolescents aged 6 to 18 years of age with ADHD.2 Stimulants and nonstimulants are the mainstays of therapy.4

Efficacy, onset of action, duration of action, and tolerability are all important factors when establishing an ADHD treatment regimen and deciding between agents.

  • Although both stimulants and nonstimulants provide significant improvements in ADHD symptoms, stimulants are more effective overall than nonstimulants2

  • Stimulants generally have a faster onset of action, while nonstimulants take up to several weeks to reach therapeutic effect5

  • Stimulants may, however, exacerbate tics, anxiety, or substance use disorder, so they should be used cautiously in patients with these conditions6

  • Stimulants can be associated with both rebound and withdrawal effects5

  • Nonstimulants may be better tolerated, especially in children who experience issues with sleep or appetite when taking stimulants4

A multimodal treatment plan that incorporates a variety of strategies is recommended for patients with ADHD7

A multimodal treatment plan that incorporates a variety of strategies is recommended for patients with ADHD9

Long-term data supports combining nonpharmacologic with pharmacologic interventions as more effective in improving outcomes for children and adults with ADHD than either treatment alone.7

  • For children with ADHD who are preschool age (<6 years old), parent- andor teacher-administered behavioral therapy is recommended as first-line treatment2

Examples of successful nonpharmacologic treatment strategies for ADHD are outlined below. As with medication management, a nonpharmacologic treatment approach should be tailored to each patient. Often a combination of strategies may be helpful.

Parent behavior therapy

For young/school-age children with ADHD, behavior therapy for parents can improve not only core symptoms, but also oppositional issues and functional impairment.

The Positive Parenting Program
(“Triple P”)
is one such parent-mediated intervention that aims to improve parent-child interactions and parenting behaviors in order to reduce behavioral issues.8 Triple P has shown efficacy in improving parenting style and mental health indices in parents—as well as moderate-to-severe behavioral symptoms in children with ADHD.8

Cognitive behavioral therapy (CBT)

CBT utilizes a skills-based approach to achieve behavior modification goals. For adolescents, there is some evidence that CBT interventions are helpful in learning techniques to manage ADHD symptoms—and in building a greater sense of agency over their disorder as they progress to adulthood.9

ADHD coaching

ADHD coaches are specialized mental health counselors who help clients develop the skills and strategies they need to achieve their personal goals and reach their full potential. The ADHD Coaches Organization (ACO) is a nonprofit organization that connects individuals with ADHD and their families to a nationwide network of ADHD coaches, either online or in their own communities.

School accommodations

Children with ADHD are entitled to additional help under primary education laws10:

  • Individuals with Disabilities Education Act (IDEA)
  • Section 504 of the Rehabilitation Act

Every state has a parent technical assistance center that can help parents of children with ADHD learn more about their child’s rights and make sure children receive an Individualized Education Program (IEP) or Section 504 plan. For specific information on school accommodations in their state, parents of children with ADHD can visit www.parentcenterhub.org/

ADHD is always present

ADHD is always present

Attention-deficit/hyperactivity disorder (ADHD) is a “24/7 disorder.” Parents frequently ask about drug holidays for their child who takes medications for ADHD. This may be because parents:

  • Feel that when school is not in session (eg, over summer break or during school holidays), there is less need for medication coverage of behavioral symptoms

  • May want the opportunity to monitor their child’s symptoms more closely over the course of a few days or weeks without medication

However, it should be emphasized that ADHD is a complex, chronic disorder; ineffective treatment may exacerbate not only core symptoms of ADHD, but the comorbidities that commonly occur.11-13

Children with untreated or undertreated ADHD are also at greater risk for social issues later in life, including1:



Substance use disorder


Legal issues


Financial instability

It should be reinforced to parents that there is no “recess” from ADHD symptoms. Moreover, treatment recommendations do not find ADHD medication holidays to be necessary unless adverse effects (eg, decreased growth velocity) are a concern.4,10

More to ADHD

Visit our patient site for resources designed for parents of children and adolescents with ADHD.

Visit MoreToADHD.com

References: 1. Barkley RA, Fischer M. The Milwaukee longitudinal study of hyperactive (ADHD) children. In: Hechtman L, ed. Attention-Deficit/Hyperactivity Disorder: Adult Outcome and Its Predictors. New York, NY: Oxford University Press; 2016:63-104. 2. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement Management, Wolraich M, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-1022. 3. Hervas A, de Santos T, Quintero J, et al. Delphi consensus on attention deficit hyperactivity disorder (ADHD): evaluation by a panel of experts. Actas EspPsiquiatr. 2016;44(6):231-243. 4. Briars L, Todd T. A review of pharmacological management of attention-deficit/hyperactivity disorder. J Pediatr Pharmacol Ther. 2016;21(3):192-206. 5. Clemow DB, Bushe CJ. Atomoxetine in patients with ADHD: a clinical and pharmacological review of the onset, trajectory, duration of response and implications for patients. J Psychopharmacol. 2015;29(12):1221-1230. 6. Clemow DB, Bushe C, Mancini M, Ossipov MH, Upadhyaya H. A review of the efficacy of atomoxetine in the treatment of attention-deficit/hyperactivity disorder in children and adult patients with common comorbidities. Neuropsychiatr Dis Treat. 2017;13:357-371. 7. Arnold LE, Hodgkins P, Caci H, et al. Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder. PLoS One. 2015;10(2):e0116407. 8. Aghebati A, Gharaee B, Shostari MH, Gohari MR. Triple P Positive Parenting Program for mothers of children with ADHD. Iran J Psychiatry Behav Sci. 2014;8(1):59-65. 9. Sprich SE, Burbridge J, Lerner JA, Safren SA. Cognitive-behavioral therapy for ADHD in adolescents: clinical considerations and a case series. Cogn Behav Pract. 2015;22(2):116-126. 10. Felt BT, Biermann B, Christner JG, Kochhar P, Harrison RV. Diagnosis and management of ADHD in children. Am Fam Physician. 2014;90(7):456-464. 11. Koolwijk I, Stein DS, Chan E, Powell C, Driscoll K, Barbaresi WJ. “Complex” Attention-Deficit/Hyperactivity Disorder, more norm than exception? Diagnoses and comorbidities in a developmental clinic. J Dev Behav Pediatr. 2014;35:591-597. 12. Brown TE. Developmental complexities of attentional disorders. In: Brown TE, ed. ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults. Arlington, VA: American Psychiatric Publishing, Inc; 2009:3-23. 13. Banaschewski T, Becker K, Dopfner M, Holtmann M, Rosler M, Romanos M. Attention-deficit/hyperactivity disorder. Dtsch Arztebl Int. 2017;114(9):149-159.