About ADHD
Treatment Q&A
1. Why is behaviour therapy being emphasised? What are the pros and cons when compared to medications?
Non-Pharmacacological therapy
Efficacy
Behavioural treatment alone is not sufficient to yield significant impact
Combined treatment yields the best treatment results on children’s overall well-being, even with lower medication dose.
Use in Young patients <6 years old
The efficacy of behaviour therapy is well established for children <12 years old and is a preferred treatment for patients <6 years old
Side effects
Behaviour therapy does not require intake of drugs and therefore a safe option
Effect after cessation of therapy
The effect of behavioural therapy is found to be long –lasting after cessation of therapy
Drug Therapy
Efficacy
Medication-alone, particularly stimulant medications, is also effective in reducing ADHD symptoms
Combined treatment yields the best treatment results on children’s overall well-being, even with lower medication dose.
Use in Young patients <6 years old
Drug therapy, owing to therapeutic concerns in extremely young age groups, should only be trialled after behaviour management for patients <6 years old
Side effects
Drug therapy may cause various side effects which could affect patient’s quality of life and compliance to therapy.
Effect after cessation of therapy
The effect of drug therapy may diminish gradually after cessation of medicine
2. Could my child avoid taking medications and receive behavioural therapy only?
Treatment plans with non-pharmacological therapy-alone is usually only recommended for pre-school children. Medications are recommended for children aged 6 – 17 since studies found medications making significant improvement in symptoms of ADHD. Behavioural treatment is not sufficient alone to yield significant impact.
3. We are busy at work and could not afford time for parent training. Could we only opt for medications for my child?
Medication alone can be effective in reducing ADHD symptoms and the combination of pharmacological and non-pharmacological treatments may vary case by case. Nevertheless, ADHD is best treated in a multimodal manner for the optimal effectiveness. Since parents are children’s major caregivers, parents’ involvement in trainings help better establish structures at home and generalise other trainings strategies to non-clinical settings, making treatment effects longer-lasting. Therefore, we do encourage parents to discuss with professionals about the optimal treatment plan, taking any concerns and limitations into account.
4. Does my child need to take the medication for life?
After reaching adulthood, whether to continue the medication for management of ADHD depends on the severity of symptoms and the mutual agreement between patient, family, and doctor. Please consult the psychiatrist for more information.
5. Is there any other treatment alternative?
A meta-analysis (Sonuga-Barke et al., 2013) in the American journal of Psychiatry Journal reported that many non-pharmacological and alternative treatments (e.g. restricted elimination diets, neurofeedback trainings and attention/ working memory cognitive trainings) showed no significant effects in reducing ADHD symptoms. The effectiveness of some other treatments (e.g. free fatty acid supplements (e.g. DHA) or artificial food colour exclusions) was small or limited to certain people. According to the UK National Institute for Health and Care Excellence (NICE) guideline, health professionals are not recommended to advise supplements or elimination of certain diets. Parents should discuss with psychiatrists before attempting alternative treatments for their children to avoid unnecessary costs in health, time, and money.
6. Can my child take a drug holiday?
Medication treatment is most effective if children fully adheres to the instruction of the psychiatrist. Stopping or reducing medication during treatment course may cause harm or withdrawal symptoms. Therefore, when the medication side effects or other factors trigger the consideration of taking drug holiday or dose reduction, consult the professional opinions from a psychiatrist before amending the treatment plan.
7. Will drug treatment lead to drug abuse?
When taken as prescribed medication, the medication will not induce euphoria and are unlikely to lead to abuse. For individuals with a risk of substance abuse, the doctor/ prescriber will run assessments and follow close monitoring in order to minimise the risk. Studies have also found that children prescribed with medication for ADHD may have a lower risk of substance abuse later in life. This may be due to the greater control on impulsivity and overall behaviour that may come with prescribed medication.