If parental management proves ineffective for
ADHD patients between the ages of 11 and 18, group or
individual counselling should be the next option considered
for treatment, the guidelines suggest.
"Drug treatment is not indicated as the
first-line treatment for all school-age children and young
people with ADHD," the guidelines say.
Treatment with Ritalin or other drugs,
"should be reserved for those with severe symptoms and
impairment," or for those who have refused or not responded
to parent training or psychological treatment.
For children with severe ADHD, medication
is still recommended as a first-line treatment, with parent
management as a supplementary treatment.
ADHD is a behavioural syndrome that leads
to symptoms such as hyperactivity, impulsiveness and an
inability to pay attention. It affects anywhere from five to
12 per cent of Canadian children.
Symptoms can range from mild to severe and
can overlap with other behavioural or mood disorders.
"With this guideline we are providing the
most comprehensive approach to diagnosing and managing
children with ADHD right across the spectrum of care," Dr.
Tim Kendall, psychiatrist and a joint director of the
National Collaborating Centre for Mental Health in the U.K.,
said in a statement.
The new guidelines fall into step with
widespread concerns that too many children are given
medication to manage hyperactive behaviours.
Ritalin can cause a variety of side
effects, such as nausea, fatigue and mood swings, and the
long-term effects of the drug are not yet known.
When children do need drug treatment,
physicians should start them on very low doses and closely
monitor side effects as they determine the correct dose for
each child, the guidelines suggest.
Doctors should also conduct an annual
review of children on medications to determine if they
should continue with drug therapy or otherwise have their
treatment altered.
