Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder affecting adolescents, children, and adults. Typically, ADHD manifests in early childhood and can progress undetected into adulthood. Individuals with ADHD have difficulties with impulse control, time awareness, concentration, hyperactivity, and motivation (Dolu et al., 2019). According to the 2021 WHO report, the prevalence of ADHD among children worldwide ranges between 2.4% and 6.5%. In the U.S., about 3 million children have been diagnosed with ADHD. Various clinical studies proclaim that the causes of ADHD are unknown. However, the interaction between environmental and genetic factors may contribute to ADHD development. Managing ADHD incorporates a broad range of pharmacological and non-pharmacological treatments. In this regard, this essay recommends one FDA-approved drug, one off-label drug, and one non-pharmacological intervention for treating ADHD among children and adolescents.
FDA-approved drug
Methylphenidate is an FDA-approved stimulant for treating children and adolescents with ADHD. Methylphenidate affects the noradrenergic and dopaminergic systems, which increases dopamine and norepinephrine levels (Dolu et al., 2019). In other words, methylphenidate blocks the presynaptic membrane, preventing the re-uptake of dopamine and norepinephrine, thereby retaining these two components in the synaptic cleft. High amounts of retained noradrenaline and dopamine in the frontal cortex, brainstem, and midbrain are thought to reduce impulsive behavior, increase concentration, and alleviate hyperactivity among ADHD patients (Dolu et al., 2019). According to the American Academy of Pediatrics (APP) guidelines, methylphenidate is the only drug administered to ADHD children aged four years. Most children and adolescents given methylphenidate as their medication experience a decrease in ADHD symptoms within ten months (Steenhuis et al., 2020). However, the best results are achieved after 14 months. The side effects of methylphenidate are short-lived and mild. The most common side effects experienced by about 70% of children and adolescents are reduced appetite and weight loss (Steenhuis et al., 2020). Other side effects include high blood pressure, rebound irritability, headache, abdominal pain, and social withdrawal. These side effects can be mitigated by making dose adjustments and choosing the right timing. For example, loss of appetite can be avoided by administering medication after the meal.
Off-label drug
Bupropion is an off-label prescription for children and adolescents with ADHD symptoms. It is an FDA-approved drug used as an anti-depressant and for treating patients with smoking habits. Various clinical trials show that Bupropion (Wellbutrin) can benefit children and adolescents with ADHD by improving their concentration (Ng, 2017). Wellbutrin functions as a norepinephrine and dopamine inhibitor. Most essentially, it is a non-stimulant type of medication. Notably, not every patient prescribed stimulant drugs such as methylphenidate undergoes a significant reduction of ADHD symptoms. In this view, non-stimulant drugs such as Wellbutrin can serve similar functions as methylphenidate by increasing norepinephrine and dopamine concentrations in the brain (Ng, 2017). The tolerability profile for bupropion drugs is relatively remarkable among children, including adolescents. Considering that bupropion serves a magnificent purpose in treating ADHD symptoms, the FDA does not recommend its usage due to its adverse effects, such as developing suicidal thoughts. Other side effects include headaches, agitation, insomnia, tremors, dizziness, constipation, blurred vision, vomiting, dry mouth, etc.
Non-pharmacological intervention
Behavioral Parental Training (BPT) proves to be an effective approach for treating children and adolescents with ADHD by improving their self-esteem, self-control, and behavior. In this intervention, parents are trained and equipped with behavioral techniques for managing children and adolescents with ADHD (Steenhuis et al., 2020). In particular, parents are trained to exhibit positive behaviors, including effective communication, encouragement, praise, etc. In addition, they should avoid any verbal criticism, poor supervision, inconsistent discipline, and corporal punishment (Steenhuis et al., 2020). Parents are also trained to display positive emotions such as warmth, affection, and love. Negative emotions such as irritability, anger, and frustration should be avoided. Doing so builds and nurtures a positive parent-child relationship, creating a conducive environment for treating the child (Steenhuis et al., 2020). BPT is a first-line and evidence-based approach recommended by most clinical guidelines to treat ADHD symptoms such as aggression, defiance, hyperactivity, anger, irritability, and school refusal. In most cases, BPT intervention is accompanied by pharmacological interventions to improve the child’s overall wellness.
References
Dolu, Nazan, Miray Altınkaynak, Ayşegül Güven, Sevgi Özmen, Esra Demirci, Meltem İzzetoğlu, and Ferhat Pektaş. 2019. “Effects of Methylphenidate Treatment in Children with ADHD: A Multimodal EEG/FNIRS Approach.” Psychiatry and Clinical Psychopharmacology 29(3):285–92. doi: 10.1080/24750573.2018.1542779.
Ng, Qin Xiang. 2017. “A Systematic Review of the Use of Bupropion for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Journal of Child and Adolescent Psychopharmacology 27(2):112–16. doi: 10.1089/cap.2016.0124.
Steenhuis, Laura, Annabeth P. Groenman, Pieter J. Hoekstra, Rianne Hornstra, Marjolein Luman, Saskia Van Der Oord, and Barbara J. Van Den Hoofdakker. 2020. “Effects of Behavioural Parent Training for Children with Attention-Deficit/Hyperactivity Disorder on Parenting Behaviour: A Protocol for an Individual Participant Data Meta-Analysis.” BMJ Open 10(11):1–8. doi: 10.1136/bmjopen-2020-037749.
