Treating Attention Deficit/Hyperactivity Disorder (ADHD)
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
—Agency for Healthcare Research and Quality
Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents
Attention Deficit/Hyperactivity Disorder (ADHD) is a neurological disorder that commonly occurs among children and adolescents, impacting the individual’s entire life, including physical activities, social life, and academic performance. Patients present with inattention, impulsivity, or excessive activity. ADHD can progress into adulthood, becoming a risk factor for unemployment and substance abuse. A combination of pharmacological and non-pharmacological interventions is encouraged after diagnosis. Psychostimulants are primarily prescribed to ADHD patients (Briars & Todd, 2016). However, not all patients respond optimally to psychostimulants, and practitioners can explore non-stimulant treatment approaches. The purpose of this paper is to identify an FDA-approved drug, an off-label drug, and a non-pharmacological intervention for treating ADHD. (Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Amphetamine products are examples of psychostimulants prescribed for ADHD. An FDA-approved drug amphetamine product is Adderall. The drug is categorized as a central nervous system stimulant. It is indicated as a first-line agent for treating ADHD in children and adolescents six years and over (Briars & Todd, 2016). It works by increasing dopamine, norepinephrine, and serotonin levels in the synaptic cleft using various mechanisms. It also inhibits monoamine neurotransmitter metabolism by inhibiting monoamine oxidase. Patient preference and abuse concerns inform the choice of agent (Briars & Todd, 2016). Dosages can range from 5 mg to 40 mg daily, not exceeding 60 mg, divided into 4 to 6-hour intervals.(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Wellbutrin is FDA-approved in treating depression and smoking but not FDA-approved in treating ADHD. However, doctors prescribe it as an off-label drug when sufficient scientific evidence is available indicating that the medication is appropriate and effective in treating ADHD. The drug is often used when the provider has concerns about a high potential for misuse and abuse, particularly among adolescents or when psychostimulants are ineffective (Verbeeck et al., 2017). About 20% of ADHD patients do not respond to psychostimulants, hence the use of Wellbutrin as an alternative non-stimulant for adolescents and adults with ADHD. This drug is also used when patients cannot tolerate side effects associated with stimulants, have a medical condition for which using stimulants is inappropriate, have mental disorders like depression that complicate an individual ADHD, and are addicted to nicotine. The drug is an antidepressant that works by increasing brain chemicals such as dopamine and norepinephrine levels in the same way as stimulants (Verbeeck et al., 2017). It also works on nicotine and serotonin receptors. It is administered as immediate-release tablets ranging between 75 mg and 100 mg. (Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Psychosocial treatments are recommended for ADHD patients as appropriate treatment, particularly for children below 11 years and younger. Psychosocial treatments include behavioral management interventions or behavioral therapy, common in children 4-6 years (Shrestha et al., 2020). Behavioral management interventions include parent training, peer-based interventions, and classroom interventions. Behavioral therapy focuses on transforming behavioral contingencies to help children enhance desired behaviors and suppress undesired ones. Parent-child therapy allows caregivers or parents to improve their parenting techniques and relationships with their children (Shrestha et al., 2020). Parents/caregivers are trained to identify problematic behaviors among children and discourage undesired behaviors using nonphysical means such as rewarding positive behavior and timeouts. However, behavioral therapy can be effective in behavior improvement but not in reducing overall ADHD symptoms.(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Prescriptions of pharmacological interventions follow a risk assessment that helps determine whether the medication is appropriate for a particular patient. The risk assessment will address adverse events, side effects, and contradictions of the recommended pharmacological treatments. These elements affect patients differently, and a risk assessment will be tailored based on patient characteristics. Risk assessment for Adderall determines that it is associated with adverse events, including height deficit and severe cardiovascular events (Briars & Todd, 2016). Practitioners should inquire about the use of other drugs, such as serotonergic agents because using them along with Adderall can raise the risk of serotonin syndrome. The drug is contradicted in patients experiencing hypersensitivity to any drug formulation component and during and within two weeks of MAOI therapy. Providers should monitor cardiac status before initial therapy. In the case of Wellbutrin, the drug is associated with side effects in some patients, including weight loss, insomnia, dizziness, headache, tachycardia, rhinitis, constipation, dry mouth, nausea, blurred vision, and tremor (Verbeeck et al., 2017). The drug is contradicted in hypersensitive or allergenic patients, patients with a seizure disorder, and those taking monoamine oxidase inhibitors. Practitioners should consider drug interaction with other antidepressants and clopidogrel.(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Clinical Practice Guideline
Clinical practice guideline for diagnosing, evaluating, and treating ADHD in children and adolescent was first published in 2000, with updates in the following years. This guideline informs recommended treatments for ADHD patients across different age groups. The American Academy of Pediatrics (AAP) clinical practice guideline recommend behavioral therapy for ADHD patients ages 4-6 years and consideration of FDA-approved medication for those above six years (Wolraich et al., 2019). Off-label drugs can be used among adolescents above 11 years in cases where FDA-approved drugs are ineffective or have severe side effects and increased potential for misuse.(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
ADHD primarily impacts children and adolescents, but it can progress to adulthood. It can be treated using medication and therapy. The AAP guideline recommends using behavioral therapy for ADHD patients between four and six years. Practitioners can prescribe FDA-approved drugs for patients older than six years. A combination of pharmacological and non-pharmacological interventions is more effective. Adolescents can be prescribed off-label drugs when the practitioner has concerns about psychostimulant drugs abuse or misuse or when psychostimulants like Adderall prove ineffective. A risk assessment is tailored to ascertain drug appropriateness for different patient characteristics. (Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 21(3), 192–206. https://doi.org/10.5863/1551-6776-21.3.192(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Translational pediatrics, 9(Suppl 1), S114–S124. https://doi.org/10.21037/tp.2019.10.01(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Verbeeck, W., Bekkering, G. E., Van den Noortgate, W., & Kramers, C. (2017). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 10(10), CD009504. https://doi.org/10.1002/14651858.CD009504.pub2(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
Wolraich, M. L., Hagan, J. F., Jr, Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., Zurhellen, W., & Subcommittee On Children and Adolescents with Attention-Deficit/Hyperactive Disorder (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528(Comprehensive Essay on Treating Attention Hyperactivity Disorder Among Children and Adolescents)
What are the 4 ways ADHD can be treated?
ADHD (Attention-deficit/hyperactivity disorder) can be treated through a combination of approaches:
- Behavioral therapy: This involves teaching individuals strategies to manage their symptoms, improve organizational skills, and develop coping mechanisms for challenges related to attention and impulsivity.
- Medication: Stimulant medications like methylphenidate and amphetamines can help regulate neurotransmitter activity in the brain, enhancing focus and reducing hyperactivity.
- Education and support: Providing individuals with information about ADHD, as well as support from educators, therapists, and family, can help them understand and manage their condition effectively.
- Lifestyle modifications: Adopting healthy habits such as regular exercise, a balanced diet, sufficient sleep, and structured routines can contribute to managing ADHD symptoms and improving overall well-being
What are the top 3 treatments for ADHD?
The top three treatments for ADHD (Attention-Deficit/Hyperactivity Disorder) typically include stimulant medications, such as methylphenidate and amphetamine-based drugs, which can help improve focus and impulse control. Behavioral therapy, such as cognitive-behavioral therapy (CBT) and behavioral parent training, is also widely recommended to teach coping strategies and organizational skills. In some cases, non-stimulant medications like atomoxetine may be prescribed when stimulants are not suitable or effective. Treatment plans often involve a combination of these approaches tailored to the individual’s needs and preferences, under the guidance of a healthcare professional.
What is the best treatment for ADHD?
The best treatment for ADHD (Attention-Deficit/Hyperactivity Disorder) typically involves a multimodal approach that combines behavioral interventions, psychoeducation, and, when necessary, medication. Behavioral therapies, such as cognitive-behavioral therapy (CBT) and behavioral parent training, can help individuals develop coping strategies and organizational skills. Psychoeducation assists patients and their families in understanding the disorder better. Medications like stimulants (e.g., methylphenidate and amphetamines) or non-stimulants (e.g., atomoxetine) can also be effective in managing symptoms, but the ideal treatment plan varies for each individual and should be tailored in consultation with a healthcare professional.
How is attention deficit hyperactivity disorder ADHD typically treated?
ADHD is typically treated through a combination of behavioral therapies, psychoeducation, and medication. Behavioral interventions often involve teaching individuals with ADHD coping strategies, time management, and organizational skills. Psychoeducation helps patients and their families understand the condition and its impact. Medications, such as stimulants (e.g., methylphenidate) or non-stimulants (e.g., atomoxetine), are often prescribed to manage symptoms like impulsivity and hyperactivity, but treatment plans vary based on individual needs and preferences. Regular monitoring and adjustments to the treatment plan are important to achieve the best outcomes.