If the child and adolescent psychiatrist or pediatrician has diagnosed ADHD, the question arises of the appropriate treatment. ADHD is not curable in the true sense, because the neurobiological causes of the disease can not be eliminated. The goal of ADHD therapy is therefore to control the main symptoms of inattention, hyperactivity and impulsivity as effectively as possible over the active day of the affected child or adolescent. This should help those affected to focus on one thing according to their age and their level of development and to be able to control their entire behavior in a self-determined manner.
Aim of ADHD therapy
The long-term goal is to give children and adolescents the chance of age-appropriate development. Only then can the cycle of negative consequences of school failure, outsiderism, addiction, etc. be broken. However, not every inattentive or overactive child has ADHD.
So before a treatment can be envisaged, a pediatrician or child and adolescent psychiatrist familiar with the condition of ADHD must always be consulted. Because only an experienced specialist can make the exact diagnosis, so that in the end the children receive a treatment that they really need.
Building blocks of ADHD therapy
German and international guidelines for the treatment of ADHD recommend a so-called multimodal therapy. This refers to a balanced combination of measures, which is based on three treatment pillars and in each case individually adapted. Three categories of treatment are considered in multimodal therapy:
- Psychological / behavioral therapy
- Accompanying educational measures
Which method of treatment is the most suitable depends primarily on how strongly the behavioral disorders are pronounced. In an independent and largest study in the world (MTA study, 1999), the combination of medication and psycho-behavioral therapy has by far the best effects on ADHD.
This study has also confirmed that overall, ADHD therapy is much more successful when it "works" throughout the day. A treatment only during school hours in the morning is usually not sufficient, because in the afternoon usually take the other therapeutic measures instead (eg, occupational therapy) and the child must be on the road, in the clique and of course in the family cope. Experts then speak of a "full-day therapy".
Psychological / behavioral therapy
A behavioral therapy has the goal of reducing unfavorable behavior and replacing it with newly learned behavior. A behavior therapy is useful if the symptoms are low or if there are other psychiatric comorbidities, such as aggressive behavioral disorders or depression. Other reasons to base the treatment mainly on a behavioral therapy: drugs do not show the desired effect, are not well tolerated or the parents have fundamental reservations about drug therapy.
At the beginning of a behavioral therapy, the parents are usually informed about ADHD so that they can fully understand the disease and its consequences and actively support the further treatment process. The next step is to investigate the extent to which established behavior patterns between parents and siblings may contribute to the behavioral disorders.
Depending on the age of the child, an individual behavioral training with the affected child is recommended. Through behavior therapy, the child learns to better perceive himself and to become aware of his unfavorable behavior in order to be able to control it better. Behavioral therapy and medication can also be used well in combination.
There are a number of medicines and substances that are used in ADHD. The most important are amphetamines, antidepressants, as well as the active ingredient methylphenidate. Amphetamines are particularly likely in children who do not respond to treatment with methylphenidate. Although these prescriptive juices or capsules are effective, they tend to be less tolerated.
With antidepressants for the treatment of ADHD, there are so far only limited application experience in Germany. However, first comparisons show an apparently lower effectiveness than methylphenidate. The active ingredient methylphenidate has been successfully used in Germany for over 50 years. It is today considered the gold standard among the available active ingredients; that is, methylphendate is the drug of first choice in drug therapy.
The drug affects the central nervous system and leads in 70 to 85 percent of cases to an effective reduction of ADHD-typical behavioral disorders. Numerous studies have shown that it is effective and well tolerated in long-term use. Methylphenidate is one of the best-studied substances in children today.
However, this substance is rapidly degraded by the body after ingestion, which is why it has a short active phase of three to four hours. For a full-day therapy - that is, a controlling effect on ADHD symptoms throughout the active day of the ADHD child - short-acting methylphenidate supplements must be taken several times a day.
In everyday life, this can often be associated with considerable difficulties for the children and their parents: The affected children and adolescents often receive the stigma of "tablet children" or punctual intake is simply forgotten, which often leads to premature discontinuation of treatment.