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Treatment of Attention deficit hyperactivity disorder

Treatment of ADHD with medicines works best when combined with additional therapies and advice and support for parents and teachers. Medication produces a short-lived improvement after each dose but is not a permanent cure. It creates a short period when the person can learn and practise new skills.


Medicines Methylphenidate is the main medicine used for the treatment of ADHD. Dexamfetamine may be used as an alternative if the child does not respond to methylphenidate treatment. These medicines are controlled drugs, which means their availability and use is more closely controlled than other prescription medicines. They are central nervous system stimulants. It is not completely clear how these medicines work in ADHD but it is thought that they stimulate a part of the child’s brain that changes mental and behavioural reactions. These two stimulants seem to affect parts of the brain, which allow us to control how we pay attention to what is going on around us.


Methylphenidate and dexamfetamine are used in children and adolescents as part of a treatment programme, which would also include psychological, educational and social support. A specialist may also treat adults with these medicines as part of a treatment programme. They are not used in people who have motor tics, whose brothers or sisters have tics or a family history of Tourettes syndrome. They may be not used in people with some thyroid or heart problems.

The length of treatment depends on how the person responds to the medicine. It would normally be stopped after one month if there was no sign of improvement but it may need to be continued for some years when it is of benefit. When the person has shown an improvement and the condition appears stable, the specialist may suggest a break from treatment, for example over a weekend or during school holidays. This helps to assess the need to continue with the medicine. Some children will be able to stop completely as teenagers, and some may be able to stop sooner. Others may have to continue as adults.


To start treatment, methylphenidate is usually given as 2.5mg or 5mg twice a day, normally at breakfast and lunchtime. A slow release tablet may be given which allows once a day dosing. This is normally reserved for when a suitable dose has been found and the condition is stable. Methylphenidate is sometimes provided as 10 mg tablets which may need to be halved, or even quartered. You can buy a pill cutter from your pharmacist.
Dexamfetamine is usually started at 5mg twice a day, normally at breakfast and lunchtime. Talk to your child’s teacher to make arrangements for them to receive their lunchtime dose.


It is best to give these medicines after a meal or snack to prevent any nausea  or loss of appetite. Doses are given at breakfast and lunchtime to provide an opportunity during this daytime period to help the person learn how to be more in control of their behaviour. A night time dose is sometimes given if the specialist decides that this would help any rebound hyperactivity in the evening. If your child experiences deterioration in concentration or behaviour in the late afternoon or evening, the specialist may suggest changing the times that the tablets are taken.
The specialist may suggest a gradual increase of the dose over a few weeks until they see a satisfactory response and to keep side effects to a minimum.

Adolescents and adults should avoid drinking alcohol during treatment because this can increase the risk of side effects.
The effect of some anti-epileptic medicines and tricyclic antidepressants may be changed if taken at the same time as methylphenidate or dexamfetamine.
It is best to avoid getting pregnant whilst taking methylphenidate and dexamfetamine as they may cause abnormalities in the unborn child. If you think you may be pregnant or would like to start a family, discuss this as soon as possible your specialist or GP. Always tell your specialist about all of the medicines being taken.

Side effects Two common side effects are nausea  and loss of appetite, particularly at the beginning of treatment. These can be helped and avoided by taking the medicines with a meal or snack.


Sleeplessness can occur often at the beginning of treatment and the specialist may suggest that you alter the afternoon dose or add in an evening dose.
In the case of children, your specialist will monitor the growth of your child during treatment if they consider it necessary.


The long-term safety of these medicines is not completely known.The specialist will include occasional blood tests and blood pressure monitoring.
The risk of dependency i.e. addiction or need for a higher dose to get the same effect is often a concern for carers of children with ADHD. To keep this risk to an absolute minimum the specialist will use the lowest possible dose and may recommend occasional breaks in treatment. It is therefore very important that you do not alter the dose that your child has been prescribed .

Other medicines If methylphenidate or dexamfetamine do not work, the specialist may consider using alternatives such as antidepressants and clonidine. Atomoxetine is a new medicine expected to be available on prescription in the UK from mid July 2004. It is not a stimulant and does not appear to have potential for abuse. However, further work is needed to assess its long-term safety profile and its place in the treatment of ADHD.

Behaviour therapies can provide support for parents, teachers and children with ADHD.
These include

  • Parenting skills training - As a parent you can learn some specific ways of talking, playing and working with your child, which have been shown to improve childrens attention and behaviour. They will explore issues such as discipline, rules, playing with their child and rewarding for good behaviour. There are a number of programmes run by professional therapists to help parents. Most of these programmes focus on behaviour management. This involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress. Programmes can be also be run for teachers
  • Counselling - A therapist will talk or play to your child to explore their feelings and examine how they are linked to their behaviour. The aim is to increase your child’s self- esteem.
  • Cognitive behaviour therapy - A therapist will work with your child with the aim of changing the way they look at situations and helping them to learn how to make decisions.
  • Social skills training - A therapist will work with your child, often in a role- play situation with the aim teaching them how to behave in social situations by picking up social cues and by learning how their behaviour affects others.


Dietary supplements, which have been used in the treatment of ADHD, include zinc supplements and polyunsaturated fatty acids. There is still little evidence to prove how these supplements work or how safe or effective they are.
No single approach to treatment is appropriate for everyone.

In adults, diagnosis is very important to help understand past difficulties. Also a combination of methylphenidate or dexamfetamine and supportive counselling, together with an antidepressant, in cases of mood disorder and anxiety, has shown to be effective.