The treatment of choice for children with moderate to severe hyperactive ADD is stimulant medication. Stimulants have been used successfully and safely for decades. In spite of recent negative publicity and some medical concerns, the drugs are safe and effective for the vast majority of children, especially those with hyperactive ADD.
Cardiac and seizure problems are the most serious, but rare risks. Tic disorders, which are involuntary muscle contractions often in facial muscles, can also rarely occur. Some mild reduction in height and weight gain over time has been noted.
On the short- term basis, loss of appetite at midday is common. Sleep problems have been noted, but I have seen relatively little of that in cases where children or adults have been properly evaluated and confirmed to have hyperactive ADD.
The two major classes of stimulants are amphetamines (Dexedrine and Adderall) and methylphenidate (Concerta, Metadate, Focalin, Ritalin). If there are problems with one class of medication, sometimes the other will be better tolerated. Typical problems that can lead to discontinuing medication are anger, moodiness, headaches, severe appetite loss, restlessness, agitation etc.
When the medications work well, these “stimulants” actually physically calm the child or adult down, along with improving attention and concentration. Many of the emotional and behavioral problems disappear rather quickly. These medications work quickly, often the first dose. Rare adverse reactions may develop later. All medication side effects or adverse effects should be reported to your doctor immediately.
Hyperactive ADD children may be a bit behind in basic reading, writing and math skills. Many children with mild deficits remit to average or above average functioning with normal activities and normal development with no intervention. Children with moderate or severe ADD may need remediation help to build skills, in and outside of school.
Counseling for hyperactive children and adults will often help build damaged self-esteem. These children and adults often underestimate their intellectual potential and that in turn tends to steer them away from challenges. Counseling can address coping strategies. Children and adults need to learn appropriate coping strategies, and not just rely solely on medication.
Hyperactive ADD children and adults literally wear out others, and they know it. Most of these children and adults have developed significant negative behaviors as a coping strategy. These may include oppositional behavior and in later years conduct disorder and anti-social behavior. They are at very high risk of school failure. They are at a high risk of alcohol and drug abuse.
Children with hyperactive ADD often become desensitized and even immune to the effects of routine discipline and punishment. Rewards mean little because they rarely achieve them. Early intervention is best, but treatment anytime is very helpful and usually necessary for this severely hyperactive population.
The treatment of non-hyperactive or inattentive ADD is relatively new. As noted in the ADD types section of this website this disorder is primarily a processing disorder. It involves a very broad array of cognitive systems. Managing incoming information at lightning speed is not easy. Since processing incoming information is very complex it is not surprising that there is less success with medication management for this type of ADD.
These ADD individuals are good candidates for cognitive/behavioral treatments, though medications can help reduce some symptoms. Non-hyperactive children often tolerate low dose stimulants. Many take medication primarily for school use only, with breaks over weekends, vacations and summer. Medications that step up norepinephrine, a neurotransmitter, may also have beneficial effects (e.g. Prozac, Zoloft, Paxil).
Typical co-occurring problems with non-hyperactive ADD include mild academic weaknesses, failure to complete work, shyness, fatigue and low motivation. These problems occur not out of laziness, but because of the genuine effort needed to accomplish routine work. If you recall how tired you can be after straining to hear a TV show at low volume, then giving up and going to bed, you’ll know how these children feel. It is a strain and effort every day.
Children and adults with non-hyperactive ADD need to learn to monitor and coach themselves in various academic and social situations.