Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Treatment & Management

Updated: Apr 24, 2017
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Treatment

Medical Care

The 2 major components in the medical care of children with attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), are behavioral and pharmaceutical therapies. The pharmaceutical component is covered in Medication.

Most components of behavioral care take place outside of the primary care provider's office. Common components are briefly described below to assist in referral and consultation. Not all components are necessary for every child.

School or education interventions

The age of the child at initial diagnosis and the severity of the symptoms of ADHD (ADD) likely affect the extent to which the child benefits from working with education specialists.

Consultants initially involved with diagnosis and evaluation can also be important in promoting the development of study skills.

Teachers have an important function. Their periodic feedback about the child's school performance through the use of standardized scales, narrative descriptions, and telephone follow-up is generally an indispensable component of ongoing care.

Implementation of academic accommodations and adaptations is often necessary

Psychotherapeutics

For adolescents, ADHD (ADD) coaching, participating in a support group, or both can help normalize the disorder and assist them in obtaining well-focused peer feedback and general information.

Counselors such as psychologists, behavioral developmental pediatricians, clinical social workers, and advanced practice nurses who are well familiarized with ADHD (ADD) can be invaluable to affected children and their families.

Behavioral modification and family therapy are usually necessary for optimal care.

Refer parent(s) for evaluation of ADHD (ADD), if suspected.

Coexisting conditions must be addressed as part of therapy.

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Consultations

The timing of consultations depends on the practitioner's degree of knowledge and experience with the evaluation and treatment of ADHD (ADD). Several possible scenarios are described below.

No consultation is necessary

In this scenario, the patient is well known and perhaps has a family member with ADHD (ADD) but no coexistent conditions. The patient has a clear history consistent with ADHD (ADD) without coexistent conditions.

Referral to an ADHD (ADD) specialist, clinic, and/or a psychiatrist or a behavioral developmental pediatrician

The patient may or may not be well known and may have a family member with ADHD (ADD) but no coexistent conditions whose condition. However, the clinician feels the patient must be questioned further about ADHD or coexistent conditions.

The patient may or may not be well known and may have no family history of ADHD (ADD) but has a concerning family history of a mood or anxiety disorder.

The patient may or may not be well known and perhaps has other family members with ADHD (ADD) whose condition is stabilized by medications without problems with coexistent conditions; however, ADHD (ADD) cannot be diagnosed and/or coexistent conditions cannot be ruled out with confidence.

A brief consultation with or referral to an ADHD (ADD) specialist or a psychiatrist or behavioral developmental pediatrician

In this scenario, the patient may or may not be well known to the practitioner, and the condition has been stabilized by medications without problems with identified coexistent conditions. However, the medication either no longer works or has started to cause adverse effects, and the medication cannot be adjusted with confidence.

Referral as soon as possible to a specialist or specialty clinic for drug rehabilitation

In this scenario, a patient is being evaluated and is not taking psychostimulants or is being re-evaluated for current psychostimulants and chemical abuse is noted. If the patient is taking psychostimulants and if the medications are being taken properly, a consultation call to decide whether the stimulants should be continued may be more appropriate than simply stopping them.

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Diet

No special diet clearly affects ADHD (ADD). Until this situation changes, a healthy diet with minimal, if any, caffeine should be emphasized. Note that, in children, caffeine is often consumed in the form of chocolate candy, chocolate milk, or "energy" drinks.

While additional studies are warranted to verify the data, the results from one study suggest that a restriction diet may reduce ADHD symptoms in some children; food color additives were identified as a possible association with ADHD symptoms. [9]

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Activity

No evidence-based studies have been conducted to elucidate the potential role of physical activity in children with ADHD (ADD). However, anecdotal clinical reports commonly attest to improvements in focus and sleep quality associated with regular physical activity and exercise. In addition, regular physical activity is important in patients with some of the common coexistent conditions (eg, depression, anxiety) and helps improve concentration. Therefore, physical activity is often an important component of therapy.

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