Attention deficit hyperactivity disorder (ADHD) - therapies

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects attention, regulation, impulse control, and other areas of executive functioning. Children who have ADHD may experience difficulty concentrating, may be easily distracted, and may have difficulty regulating energy levels and emotional responses.

ADHD can continue into adolescence and adulthood, and support needs may change across the lifespan.

Treatment for ADHD needs to be tailored to each child and should consider their goals and circumstances.

Treatment using medication is fast and can assist with improving concentration and attention, but using medication alone may not be the best treatment for a child with ADHD. Non-medication therapies are often combined with medication therapies to treat ADHD.

Treatment may include:

• medication
• educational programs
• behavioural support
• psychological counselling
• family support.

Medication for ADHD

Stimulant medications (such as dexamphetamine and methylphenidate) are the most commonly-used medications for ADHD. They act on the release of dopamine, which is a neurotransmitter (brain chemical). Greater amounts of dopamine can increase concentration and curb hyperactive and impulsive behaviours.

Dexamphetamine and methylphenidate are similar but different in their chemical makeup and effects, so your child may benefit more from one of these medications than the other.

Different types of medication for ADHD

Stimulants

• Short-acting – immediate release (IR) forms of stimulants that last about 3 hours, including:
  • Ritalin
  • Dexamphetamine
• Long-acting forms – including:
  • Ritalin LA – lasts 6 to 8 hours
  • Concerta – lasts 10 to 12 hours
  • Vyvanse – lasts more than 12 hours.

Non-stimulant medications

• Strattera
• Intuniv
• Clonidine.

Dosage for ADHD medications

Any changes to medications should always be supervised by the prescribing doctor. They may need to adjust the dosage and timing for your child to get the best outcome while minimising possible side effects. For both dexamphetamine and methylphenidate, the dosage may be gradually increased over 3 or 4 weeks, using half tablets if necessary.

The doctor may stop the medication if your child shows no improvement at the end of 4 weeks. The other medication can then be trialled in a similar way. If the medication works, the doctor may increase the dose as your child grows.

Side effects of stimulant medications for ADHD

The main short-term side effects are poor weight gain and decreased appetite. Some others include:

• sleeping problems, such as delayed sleep onset
• headache
• drowsiness
• stomach pains
• nausea and vomiting
• dry mouth
• high blood pressure
• tachycardia (increased heart rate)
• emotional changes such as irritability, depression, nervousness or anxiety
• hallucinations (seeing or hearing things that are not really there) or psychotic symptoms (major mental illness)
• development or worsening of tics (repeated, uncontrolled movement of a muscle, often in the face).

Follow-up treatment

Children who are taking medication for ADHD support should see their health professional regularly (at least every 6 months). These check-ups include:

• a thorough physical examination
• a review of your child’s general health and wellbeing to see if ADHD symptoms require additional or different types of support.

Other medications for ADHD

Other medications are sometimes prescribed to support co-occurring challenges, such as sleep difficulties (melatonin, clonidine) or anxiety (SSRIs).

ADHD urgent prescription top-ups

Children and adults may be able to access a one‑off short-term emergency prescription for ADHD medication through the Virtual Emergency Department. This service is available for children and adults who:

• have an existing ADHD diagnosis
• urgently need a repeat prescription to access their ADHD medication
• can’t access the medication through their regular treating doctor.

Children, families and adults will consult a specialist doctor via video call. The doctor will review and verify the person’s current medication and dosage and, where clinically appropriate, provide a short-term prescription. Prescriptions can be sent directly to a local pharmacy or to the person’s preferred electronic device via SMS.

This service is intended as a short-term emergency measure and does not replace ongoing ADHD prescribing and management by a person's regular treating doctor.

See the Virtual Emergency Department for details.

Non-medication therapies for ADHD

Therapies for ADHD need to be tailored to the individual child. Some therapies are more useful for helping with developing emotional regulation skills, while others are better for teaching strategies around managing impulsivity.

Generally, the range of non-medication therapies used for ADHD can include:

• education support
• behaviour support
• cognitive therapy
• emotional regulation skill development
• friendship support
• individual and family counselling.

Behaviour support for ADHD

Behaviour support therapies, when delivered in a neuro-affirming way (recognising individual developmental differences), can help children develop skills that support safety, emotional regulation and participation in daily activities. They may also be used when behaviours place the child or others at risk.

Research has shown that therapies targeting behaviour are more successful when the child has an active role in deciding on elements of the program, its goals and outcomes. Therapies that aim to change behaviour by punishment or restricting access to things the child needs or enjoys do not work and are not considered contemporary best practice. Positive reinforcement, explicit teaching, visual/verbal prompts and cues, and environmental supports are far more effective.

Family and caregiver engagement is also important to ensure the child is well supported when learning and embedding new skills.

Cognitive therapy and ADHD

Cognitive therapy aims to help the child develop critical ‘thinking skills’, such as problem solving and impulse-control. Therapeutic activities can include role playing and working out in advance how to handle particular situations.

The child learns to think through the possible consequences of an action before performing it. For example, the first self-instruction could be ‘Stop!’ followed by ‘What is the problem?’ and ‘What would be the best plan to solve the problem?’. Cognitive therapy may be helpful for children who are impulsive and possibly engaging in more risky behaviour.

Emotional regulation and ADHD

Children who are quick to anger or who have difficulty with appropriate emotional responses can benefit from support to monitor and regulate their mood. The child learns how to recognise the signs of their growing frustration and apply a range of coping skills designed to defuse their anger. They also learn relaxation techniques and stress management skills.

Social support and ADHD

Children with ADHD may struggle with peer relationships (children of the same age) if social interactions are challenging for them. This can particularly be the case if they struggle with understanding social expectations, turn taking, emotional regulation during play, and responding to social cues. Being bullied, ignored or teased by peers can contribute to low self-esteem.

Therapies focused on supporting friendships and positive social interactions can teach your child how to interact with others in a way that is safe and enjoyable for everyone. Role playing is a strategy often used in these sessions.

Your child may learn basic skills such as:

• different ways of starting a conversation
• listening skills
• how to play cooperatively with others.

Family counselling and ADHD

Family counselling aims to help caregivers and the other members of the household understand ADHD, recognise their child's strengths and support them to participate successfully at home, school and in the community.

Reading books about ADHD and joining an ADHD support group can also help. For example, parents may learn different strategies to overcome some of the challenges their child may be experiencing. More general information and assistance is available through local or community organisations and ADHD Australia.

Aboriginal and Torres Strait Islander families may wish to access support through Aboriginal Community Controlled Health Organisations or healthcare providers with experience delivering culturally safe care.

Diet and ADHD

There is no evidence that ADHD is caused by certain foods (such as food additives). Some studies have found that small numbers of children with ADHD may benefit slightly from dietary changes, though changes to diet, unless for other health reasons, are not recommended as a routine part of therapy.

Talk with your doctor or a dietitian before changing your child’s diet to help with ADHD.

Alternative therapies

There are various alternative therapies that claim to help children who have ADHD. In many cases, the claims have not been proven.

Some controversial and unproven alternative therapies for ADHD include:

• Treatment for allergies – some people believe that allergies cause ADHD. Suggested treatments include homeopathic remedies and special diets.
• Vision training – with coloured eyeglasses.
• Vitamin supplements – Fish oils with omega-3 fatty acids have recently received special attention, because there is some evidence that suggests children with ADHD have low omega-3 levels. Increasing omega-3 levels may result in small improvements in ADHD symptoms like poor attention, impulsivity and challenges with emotional regulation in some children. However, not all studies show such improvements, and supplements are not a recommended replacement for other therapeutic supports.

Where to get help

• Your GP (doctor)
• Paediatrician
• Psychiatrist
• Psychologist
• ADHD Australia