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.
