TREATMENT
The treatment of ADHD is based on medication and behavioral modification. Some doctors liken medication treatment to eyeglasses: they help the patient focus the world, but the rest is up to the patient themselves. Medication alone, however, cannot improve all of the symptoms. Medications must be combined with behavioral therapy at home and at school. Limitations and rule setting must be consistent to improve behavior in people with ADHD. The person with ADHD must learn new ways to relate to his/her family and the world. Group or family therapy may be helpful.

Stimulant medications, such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert) have been unequivocally shown to improve the symptoms of ADHD. It is useful to think of their seemingly paradoxical mechanism as the brake in a car. When the brake is stimulated, the car slows down. Seventy-five percent of children with ADHD will respond to stimulants. The doctor will usually start with a low dose, and then gradually increases it until the dose is found that works the best with the least side effects. Medication dosage can vary between children based on body weight, diet, and other factors. The medications are usually given 2-3 times per day, depending on the patient. Some patients need only take the medication on school days; others require the medication every day. Many physicians suggest that the patient have an annual "drug holiday", in which the medication is stopped, in order to assess the severity of remaining symptoms. These usually occur during school vacations.

Certain antidepressants, such as amitriptyline (Elavil), desipramine (Norpramin), buproprion (Wellbutrin), fluoxetine (Prozac), and sertraline (Zoloft), have also been found to be effective in ADHD, especially when ADHD is accompanied by depressive symptoms.

Clonidine (Catapres) is another class of medication sometimes used in the treatment of ADHD. Clonidine acts on the central nervous system and is especially helpful if the symptoms are primarily hyperactivity, aggression, or if tics are present. It is available as a pill or as a patch.

Side Effects
All of the stimulants have the potential to cause insomnia, decreased appetite, stomach ache, headache, and jitteriness. Often, a slight decrease in dose can eliminate the side effects. Giving the medication after meals can reduce the effects of decreased appetite. Growth appears to be affected only as a result of decreased appetite. Your physician will monitor the child's growth while on the medication. Pemoline (Cylert) has been found to cause rare cases of liver failure, so it is usually not used unless other treatments have failed.

The antidepressants have different side effects depending on their class. Serotonin Specific Reuptake Inhibitors (SSRI) antidepressants, such as Prozac and Zoloft, have few serious side effects. Minor side effects include dry mouth, blurry vision, and sexual dysfunction. Tricyclic antidepressants, such as amitriptyline and desipramine, can cause blurry vision, dry mouth, constipation, and difficulty voiding. These medications should not be used in patients with a certain cardiac condition (long or prolonged QT syndrome). An EKG is often performed before starting treatment with a tricyclic antidepressant.

Clonidine can cause fatigue and decreased blood pressure. Blood pressure should be monitored before starting treatment and regularly while on this medication.