ADHD treatment

It should be highlighted that pharmacological treatment in ADHD is indicated for patients with moderate or severe symptoms that have a significant effect in school, on their work or family and social life. The level of efficacy in reducing symptoms is very high, at 70-90%. The drugs attenuate the symptoms and facilitate psychological and psychopedagogical treatment.  Drugs from three main families are administered:  

• Psychostimulants: These increase the release of dopamine, which is the substance that helps transmit electrical stimuli from one brain neuron to another. The brain of a person with ADHD usually has less stimulation. Clinical guidelines consider psychostimulants as the first therapeutic option. Their efficiency is 70-90%.  
• Noradrenergics: They stimulate the release of norepinephrine, also involved in the origin of ADHD. Currently, only atomoxetine is administered. This is considered as a second therapeutic option. This is not a psychostimulant. It has demonstrated safety and tolerance in the short and long term. It has no abuse potential.  
• Alpha adrenergic agonists: These release adrenaline; examples are clonidine and guanfacine. These drugs are normally used to lower blood pressure, but have been shown to reduce impulsiveness and aggressiveness in children with ADHD. They are used as a third therapeutic option, generally in combination with another specific ADHD drug.

• For psychostimulants: They are uncommon and many diminish over time. Among the most notable effects are decreased appetite, difficulty in falling asleep, gastrointestinal discomfort, motor restlessness, sadness, behavioural rebound effect, irritability and headache. At the cardiovascular level, they can increase heart rate and blood pressure, so these should be recorded before starting drug administration.  
• For noradrenergics: Among the most prominent side effects are gastric discomfort, dizziness, dermatitis, drowsiness, blood pressure and heart rate effects and irritability. One notable possible affective alteration during the first month for some children is an increase in suicidal ideation, which is already frequent in patients with ADHD (50%).  
• For alpha adrenergic agonists: Among the most important side effects are drowsiness, hypotension, weight gain, headache, fatigue and abdominal pain.

Cognitive behavioural or behavioural psychotherapy have been shown to be the most effective psychological treatments to improve the disorder. This applies to young children, adolescents and adults. For minors, parents and teachers are also trained to apply cognitive-behavioural strategies.

The main objectives of psychotherapy are for children to understand what is happening to them, collaborate in the treatment, realise they are not "to blame" for these difficulties, but that they should accept and take responsibility for treating them, as is done in other areas of health (for example, if you going to the dentist for braces you should agree to take care of them).

Other objectives are to improve the child's behaviour, self-control (thus reducing aggressive behaviour) and compliance with habits: e.g., doing homework, showering and dressing.

An incentive system is used to improve the delay in the development of motivation, moving from external motivations (prizes) to internal ones little by little. For example, “to study in order to get good marks".  

Social skills are also worked on, such as the use of assertive communication. Training is also given for identifying feelings and emotions, so they learn to express any anger verbally instead of via behaviour, for example.  

Adolescents and young people must have all the information about their disorder to increase self-awareness of the difficulty, prevent risks and accept treatment. It is essential to work on strategies for time control, motivation, tolerance to frustration as well as for order and planning.

This psychological treatment is aimed at families learning to manage their child's behaviour, using techniques that have proven effective in treating ADHD.

Some of these techniques are: Keep records of objectives agreed with the young child or adolescent, with incentive systems established and applied, as well as the withdrawal of privileges when they do not comply and the management of complaints or threats. Training in problem-solving should also be carried out.  

Strategies to improve communication between parents and children should also be included, such as giving orders, promoting self-esteem and facing changes.

When teachers are aware a student has the disorder and understand how to help the child, they can better adapt the environment to the child's difficulties. Thus, they should use some methods for greater control of the behaviour of these children and increase the possibility of them being successful in school tasks.  

Some of these techniques are: paying more attention to the positive behaviour of the child, teaching them how to structure homework and structuring the progress of the class so children with ADHD can follow it better. For example, to insert periods of reading with physical exercise.

The teacher should be able to identify behavioural problems and record the child's progress.

Coordination with the school or educational psychologist and health professionals should be made possible to establish common goals and shared strategies.