Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder that manifests in children and adults. It has three core symptoms: hyperactivity, inattention, and impulsivity. These symptoms affect the ability to pay attention to details, organise, socialise with others, and plan – all things needed for success in school and life.
This article discusses treatment options for ADHD with various strategies, including medications (primarily stimulants), behavioural therapies like atomoxetine, neurofeedback therapy (Ritalin), or psychotherapy.
There are many different ADHD treatments in Singapore. The ADHD medication market is booming in the United States with new drugs and new formulations of old drugs. Currently, there are only three FDA-approved medications for ADHD treatment in Singapore: methylphenidate (Concerta, Metadate, Methylin, Ritalin), dextroamphetamine (Dexedrine), and amphetamine-dextroamphetamine combination (Adderall). Atomoxetine is a non-stimulant approved for the treatment of ADHD.
Additionally, there are other stimulants, including pemoline (Cylert) or modafinil (“Provigil”), that are approved to treat narcolepsy, but they have been used off-label to treat ADHD. New drugs using non-stimulant technology are also being tested for ADHD.
It is essential to evaluate whether a child or adult has ADHD before starting a treatment. The diagnosis should be confirmed by a qualified professional. If your child displays three or more symptoms of the disorder, then he is most likely to have ADHD. These symptoms include:
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for ADHD:
Many different types of testing can be done to determine whether someone has ADHD and whether they are responding positively to a treatment plan. The two most commonly used tests for ADHD are the Conners Scale/Conners’ Teacher Rating Scale (CTRS, CTRS-R) and the Conners Parent and Teacher Rating Scale (CPT). The Conners’ Scales are available in both paper and computerised format. A parent or teacher can administer these scales. The Conners Parent and Teacher Rating Scales have an adolescent form that is more appropriate to use with the teenager.
The results of these scales should be interpreted by a qualified professional who understands ADHD, how it manifests, how best to treat it, how to evaluate it, and what other conditions may co-exist.
ADHD medications are a mainstay of treatment for ADHD. Adolescents (12-19) take a stimulant medication almost 60% of the time, adults (20-49) take it around 70%, and finally, children (6–11) on average are given a stimulant 51% of the time. The two most commonly prescribed stimulant medications are methylphenidate and dextroamphetamine.
There has been some debate about whether methylphenidate or dextroamphetamine is more effective. According to clinical studies, both drugs have positive effects on ADHD symptoms; however, some psychiatrists feel that the different doses of these drugs affect adults more than children regarding mood and behaviour.
Methylphenidate: The Mental Status Exam (MSCE) rating scale can be used as a measure of methylphenidate’s effectiveness over some time. The MSCE is a commonly used tool in research, but it is not very accurate in diagnosing ADHD in children because it does not account for comorbid psychiatric disorders.
The self-report scale for parents (SPARS) after 8 weeks with methylphenidate is an effective and easy-to-administer tool for measuring treatment outcomes. Results show that the child showed improvement in all four symptom categories; however, their parent’s rating scale still showed considerable improvement.
