Once the child and adolescent psychiatrist or pediatrician has diagnosed ADHD, the question of appropriate treatment arises. ADHD is not curable in the true sense of the word because the neurobiological causes of the disorder cannot be eliminated. The goal of ADHD therapy is therefore to control the main symptoms of inattention, hyperactivity and impulsivity as effectively as possible throughout the active day of the affected child or adolescent. This is to help the affected person focus on one thing at a time, according to their age and stage of development, and to be able to control their overall behavior in a self-determined manner.
Aim of ADHD therapy
The long-term goal is to give children and adolescents the chance to develop according to their age. This is the only way to break the cycle of negative sequelae of school failure, being an outsider, addiction, etc.However, not every inattentive or overactive child has ADHD. Before treatment can be considered, a pediatrician or child and adolescent psychiatrist familiar with ADHD must be consulted. Because only an experienced specialist can make the exact diagnosis, so that in the end the children receive treatment that they really need.
Building blocks of ADHD therapy
German and international guidelines for the treatment of ADHD recommend a so-called multimodal therapy. What is meant by this is a balanced combination of measures based on three treatment pillars that are individually adapted in each case. Three categories of treatment measures are considered in multimodal therapy:
- Medication
- Psycho-/behavioral therapy
- Accompanying educational measures
Which therapy method is the most appropriate depends primarily on how severe the behavioral disorders are. In an independent and the world’s largest study on this subject to date (MTA study, 1999) has shown that the combination of medication and psycho-/behavioral therapy has by far the best effect on ADHD. This study also confirmed that ADHD therapy is much more successful overall when it “works” throughout the day. A treatment only during the school hours in the morning is usually not sufficient, because in the afternoon usually the other therapeutic measures take place (e.g. an occupational therapy) and the child must get along in the traffic, in the clique and naturally also in the family. Experts then speak of a “full-day therapy”.
Psycho-/behavioral therapy
Behavioral therapy aims to reduce unfavorable behaviors and specifically replace them with newly learned behavior. Behavior therapy is useful when symptoms are mild or there are other concomitant psychiatric disorders, such as aggressive behavior disorders or depression. Other reasons to base treatment mainly on behavioral therapy: Medications do not show the desired effect, are not well tolerated, or parents have fundamental reservations about drug therapy. At the beginning of behavioral therapy, parents are usually educated about ADHD so that they can fully understand the disorder and its scope and actively support the further treatment process. The next step is to examine the extent to which entrenched behavior patterns between parents and siblings may be contributing to the behavioral problems. Depending on the age of the child, individual behavioral training with the affected child himself is also recommended. Through behavioral therapy, the child learns to become more self-aware and aware of his or her unhelpful behavior so that it can subsequently be better controlled. Behavior therapy and medication can also be used well in combination.
ADHD Medication
There are a number of medications and substances that are used for ADHD. The most important are amphetamines, antidepressants, and the active ingredient methylphenidate. Amphetamines are mainly considered for children who do not respond to treatment with methylphenidate. These prescription juices or capsules, while effective, are usually not as well tolerated. With antidepressants for the treatment of ADHD, there is so far only limited application experience in Germany. However, initial comparisons show an apparently lower efficacy than methylphenidate.The active ingredient methylphenidate has been used successfully in Germany for over 50 years. Today, it is considered the gold standard among the available active ingredients; in other words, methylphenidate is the drug of first choice in drug therapy. The active ingredient affects the central nervous system and leads to an effective reduction in the behavioral disorders typical of ADHD in 70 to 85 percent of cases. Numerous studies have shown that it is effective and also well tolerated in long-term use. Today, methylphenidate is one of the best-studied substances ever in children. However, this substance is broken down very quickly by the body after ingestion, which is why it only has a short effective phase of three to four hours. For a full-day therapy – i.e. a controlling effect on ADHD symptoms throughout the ADHD child’s active day – short-acting methylphenidate preparations must be taken several times a day. This can often be associated with significant difficulties in everyday life for the children and their parents: Affected children and adolescents often receive the stigma of being “pill kids” or simply forget to take their medication on time. This not infrequently leads to premature discontinuation of treatment.
