ADHD

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About ADHD

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Overview

ADHD is one of the most common behavioral problems diagnosed among school-aged children in the United States. The Centers for Disease Control and Prevention estimates that about 9 percent of children ages 5 to 17 are affected. The National Comorbidity Study Replication estimated about 4.4 percent of adults in the U.S. have ADHD. Boys are much more likely to be diagnosed with ADHD than girls. Perhaps this is because boys are prone to act out and exhibit hyperactivity, while girls with ADHD are more likely to be perceived as simply inattentive (daydreaming, forgetful, or easily distracted) without any significant hyperactivity or disruptive behavior. The pattern of abnormal behavior usually begins before age 7.

It’s normal for children to have difficulty paying attention and controlling their behavior at times. And it’s certainly common for parents to think that their children are sometimes a bit wound up. Indeed, almost every child (and many adults) have bouts or periods of hyperactivity, lack of focus, and poor attention. This does not mean they have a mental or behavioral disorder.

What should lead you to suspect ADHD is a persistent pattern lasting at least six months of abnormally high levels of physical activity (hyperactivity), impulsivity, and/or lack of ability to pay attention and focus or complete tasks. The severity of symptoms and abnormal behavior patterns in children and teenagers with ADHD varies widely. Some children have only mild symptoms while others are severely affected. The range of symptoms among adults has not been well studied.

Common Symptoms

Inattention

  • Difficulty paying attention to details
  • Frequent hasty mistakes in schoolwork, work, or other activities
  • Difficulty sustaining attention in performing tasks or play activities
  • Difficulty listening when spoken to directly
  • Unable or slow to complete assignments and tasks
  • Difficulty organizing tasks and activities
  • Loses things necessary for tasks or activities
  • Easily distracted by extraneous stimuli or sights or sounds
  • Easily bored
  • Forgetful in daily activities
  • Tendency to daydream

Hyperactivity and Impulsivity

  • Fidgets with hands or feet or squirms in chair
  • Leaves seat in classroom or in situations in which remaining seated is expected
  • Runs around excessively in situations in which it is inappropriate
  • Difficulty engaging in leisure activities in a quiet manner
  • “On the go” or acting as if “driven by a motor” much of the time
  • Excessive or impulsive talking
  • Blurts out answers before questions have been completed
  • Difficulty in waiting for his or her turn to speak
  • Interrupts or intrudes on others
  • Hot-tempered; easily agitated or angered
  • Low tolerance of stress

What Causes it?

Doctors don’t know exactly what causes ADHD, but the environment and certain genes might play a role. Some kids might be biologically prone to the condition, and it could be triggered by factors in their home or school environment, such as exposure to lead. Some studies have suggested children whose mothers smoked and drank alcohol during pregnancy have an increased risk of ADHD.

Consumer Reports Best Buy Picks

Methylphenidate (generic Ritalin)

Cost: $15-$38/mo

Methylphenidate Sustained-Release (generic Methylin ER, Concerta)

Cost: $32-$197/mo

Our analysis found that stimulant medications, such as methylphenidate (Ritalin), are somewhat more effective than nonstimulant medications, which include Intuniv, Kapvay, and Strattera. Our assessment indicates that none of the stimulants are clearly more effective than any other. Each raises different safety issues, however, and you should discuss them with your doctor. Dosing convenience (taking one pill a day instead of two or more; oral solutions for those who have difficulty swallowing tablets; or the use of a skin patch), and the period of time that a medicine is active in your body are critical elements of ADHD treatment.

Methylphenidate has been on the market for decades and has proven to be effective and safe for most people when used as directed. It is available as a low- or moderately-priced generic, and “branded” generics (generic drugs sold under trade names, but which are often less-expensive than branded drugs, yet slightly more costly than a regular generic). Methylphenidate is supported by a large body of comparative evidence, and it has a slightly lower incidence of mild side effects, and a lower potential for abuse than dextroamphetamine.

Other Prescription Drugs Evaluated

  • Adderall, Adderall XR (amphetamine)
  • Dexedrine (dextroamphetamine)
  • Vyvanse (lisdexamfetamine)
  • Concerta, Daytrana patch, Metadate CD/ER, Methylin oral solution, Methylin chewable tablet, Methylin ER, Ricalin, Ritaling LA/SR (methylphenidate)
  • Strattera (atomoxetine)
  • Kapvay (clonidine)
  • Intuniv (guanfacine)

We do not include the drug modafinil (Provigil), which is used for treating certain sleep disorders. Some doctors might prescribe it as an ADHD treatment, but this medicine is not approved by the FDA to treat the condition, and it has been associated with a serious rash. We advise caution if it is used.

Is it Effective?

Both the stimulant and nonstimulant medications used to treat ADHD are effective and generally safe when used as directed. All have been proven to reduce hyperactivity and disruptive behavior and to improve attention and concentration in 60 to 80 percent of children and teenagers with ADHD in the short-term.

Our analysis indicated that stimulants are somewhat more effective in reducing ADHD symptoms than nonstimulants, in general. However, choosing a nonstimulant in some cases will be preferred (for example, a person who can’t tolerate the side effects of stimulants), and the difference is typically small. Our assessment indicates that none of the stimulants are clearly more effective than any other.

Long-term Treatment

There is uncertainty about how long the benefits of ADHD medications last because no good quality studies have looked at continued treatment for longer than a couple of years. Some smaller studies of children who took methylphenidate found that improvements started to decrease, at least somewhat, as early as nine months to two years after starting treatment. Given these uncertainties about long-term effectiveness, the decision about whether to stop medication must be made on an individual basis. Some children might benefit from continuing to take a medication. However, some children seem to "outgrow" their ADHD symptoms, so medication might not be beneficial or necessary after a while. One option is to stop taking the medicine for a brief period to see if you or your child notices a difference.

Is it Safe?

The side effects associated with ADHD medicines usually occur early in treatment and tend to be mild. The most common for stimulants include decreased appetite, difficulty falling asleep, headache, irritability, jitteriness, and stomachache. For the nonstimulant drug atomoxetine (Strattera), the most common side effects in children include decreased appetite, dizziness, fatigue, mood swings, nausea, and upset stomach.

The most common side effects with the newest nonstimulant drugs, clonidine (Kapvay) and guanfacine (Intuniv), are sleepiness, tiredness, and small changes in blood pressure or heart rate. All of the stimulant ADHD medicines and atomoxetine have also been linked to rare cases of heart attack, stroke, and sudden death. As a result, the FDA has strengthened its cautions about these potential risks on the labeling of these drugs.

Addiction

The risk of addiction among children and preteenagers taking stimulants for ADHD is very low and has not generally been reported. Still though, parents of teenagers and college students prescribed stimulants for ADHD should closely monitor use of the medicine.

Are there Non-Drug Options?

Non-drug Treatments

Other nondrug treatments include dietary restrictions, such as eliminating sugar or other food items; taking nutritional supplements, such as herbals or high doses of vitamins; and using biofeedback, or vision therapy. But none of these are backed by credible evidence that they improve ADHD symptoms, and some, such as high doses of vitamins, can be dangerous.

Behavioral Therapy

In the short run, the most effective strategy for treating ADHD in children is a multipronged approach that uses a combination of treatments, including medicines and behavioral therapy. Therapists might also help parents, and sometimes teachers, build the skills to cope with, and respond appropriately to, a child’s ADHD behaviors. The use of drugs to treat ADHD has been more thoroughly evaluated over the years than other forms of treatment. But there is some evidence that the combination of behavioral therapy and drugs can work better than drugs alone for some children. There’s mixed evidence on how well behavioral therapy works when used without drug treatment. It certainly does not work for all children, especially those who have severe symptoms.

Off-Label Drugs

Other drugs are sometimes used to treat ADHD. But there’s no conclusive, systematic evidence they work, and they are not FDA-approved to treat ADHD. So we advise caution.

These drugs include the antidepressant, bupropion (Wellbutrin); tricyclic antidepressants; the shortacting forms of high blood pressure medicines, clonidine (Catapres) and guanfacine (Tenex); along with several antipsychotics: aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).

We recommend that the medicines not approved to treat ADHD be used very cautiously, and only after a thorough discussion with your doctor. They should probably be used only when a child, teenager, or adult cannot take a stimulant or one of the three nonstimulants approved for ADHD due to side effects or lack of efficacy, or when the presence of another condition (such as depression or anxiety) warrants treatment with the non-approved drug.

Source

Consumer ReportsBest ADHD Medication. We compare how well the drugs work, their safety and their price. Published March 2012.

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