A large number of studies65 have documented the powerful and clear-cut efficacy of medications, especially the stimulants, on the core symptoms of attention deficit hyperactivity disorder (ADHD). These medications also improve oppositional behaviors; increase appropriate interactions with family members, peers, and teachers; and improve participation in extracurricular and leisure activities. (Because ADHD is a disorder that affects most children throughout their waking hours, medications should not be limited to school hours only.)
Before a child is placed on a medication regimen, his or her baseline target symptoms should be established, and these symptoms should be monitored throughout the course of treatment. One of the checklists used during the evaluation process should be used to monitor efficacy of treatment at home and at school.
As ADHD medications still are associated with some stigma and are relatively short-acting, compliance can be a major problem. Even a few missed doses in a week can cause a teacher to report no changes or worsening behavior during a medication trial. A critical component of any psychoeducational session is to underscore the importance of compliance with the medication regimen and to find mechanisms for enhancing and monitoring compliance.
More than one medication may have to be used to treat ADHD. Reasons include:
For example, children with comorbid anxiety or depression may require the addition of a selective serotonin reuptake inhibitor. A youngster who exhibits aggressive symptoms along with ADHD or who has early-morning symptoms may benefit from the combination of a stimulant and an alpha2-adrenergic agonist.
When a patient is being treated with more than one medication, only one medication at a time should be manipulated.
With combined pharmacotherapy, the possibility of increased side effects always must be considered.
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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