The high prevalence of ADHD and the co-morbidity of most children with other behavioral disorders cause extensive and lasting damage to children’s learning, life, family and partnership, so early diagnosis and systematic and standardized treatment are very important. Through multidisciplinary, long-term, multimodal and individualized comprehensive treatment, we can alleviate and improve clinical symptoms, reduce the occurrence of co-morbidities, improve social function, enhance self-confidence and improve social adaptation ability.
Education of disease knowledge
All children diagnosed with ADHD and their parents/guardians should be educated about the disease. This education includes understanding the nature of the disease, the possible causes of the disease, how to cooperate with professional treatment, and how to maximize the prognosis of the child.
Drug therapy
Overall treatment goals
1. ADHD is a chronic neurological and psychiatric disorder, and a long-term treatment plan should be developed first.
2. for each individual, an appropriate individualized treatment goal should be defined to guide treatment.
3. clinicians should recommend appropriate pharmacological and psycho-behavioral treatment to improve the target prognosis of children with ADHD; if the treatment plan chosen for a child with ADHD does not meet the treatment goals, clinicians should evaluate whether the initial diagnosis is correct, whether the treatment used is appropriate, how well the treatment plan is followed, and whether there are co-morbidities.
4. Clinicians should conduct regular and planned follow-up visits for children with ADHD to summarize information to directly monitor target prognosis and adverse effects.
Principles of drug therapy
1. Consider the child’s previous treatment and current physical condition to determine the order of medication use.
2.Based on the principle of individualization, start with a small dose and gradually adjust it to reach the optimal dose and maintain the treatment.
3.Use appropriate methods to evaluate the efficacy of drugs during the treatment process.
4.Pay attention to the possible adverse reactions.
Optional drugs
1, methylphenidate: oral. for children over 6 years old. It is divided into immediate-release tablets and extended-release tablets according to the duration of efficacy. The starting dose of immediate-release tablets is 2.5mg~5mg per time, 2~3 times a day, and increase 5~10mg per week depending on the condition; the starting dose of extended-release tablets is 18mg per time, once a day, taken in the morning, and the dose is adjusted depending on the condition. If the child does not tolerate the side effects of methylphenidate or the symptoms do not improve further after the dose is increased, then the above dose is the optimal treatment dose.
Contraindications: Patients with significant symptoms of anxiety, stress, and agitation; patients with known hypersensitivity to methylphenidate or other components of the product; patients with glaucoma; patients with a family history or diagnosis of Tourette’s syndrome; patients who are being or have been treated with monoamine oxidase inhibitors within 14 days.
Common adverse reactions include loss of appetite, dizziness, headache, insomnia, nausea, and irritability. Serious adverse reactions include cardiac arrhythmias, suicidal ideation, hematuria, myalgic cramps, rhinorrhea, growth inhibition, and visual disturbances. Rarely, hepatic damage, myocardial infarction, cerebral arteritis, psychiatric abnormalities, malignant syndrome (manifested by muscle tension, hyperthermia, impaired consciousness, profuse sweating, unstable blood pressure), leukopenia and thrombocytopenia, closed-angle glaucoma, exfoliative dermatitis, erythema multiforme, etc.
2. Tomoxetine: Oral. for children over 6 years old. For children or adolescents weighing less than 70 kg, the starting dose is 0.5 mg/kg per day, and the dose is increased after 3 days according to the effect to the total daily target dose, usually 1.2 mg/kg per day, which can be taken once in the morning or divided equally into 2 doses in the morning and evening, with the maximum daily dose not exceeding 1.4 mg/kg. 40mg per day and increase the dose after 3 days depending on the effect to the total daily target dose, usually 80mg per day, either as a single dose in the morning or divided equally into 2 doses in the morning and evening. After 2 to 4 weeks of continued use, if optimal efficacy is not achieved, the total daily dose may be increased to a maximum of 100 mg.
Contraindications: closed-angle glaucoma; patients who are taking or have taken monoamine oxidase inhibitors (e.g., phenelzine, phencyclidine, etc.) within the previous 14 days; hypersensitivity to the product or its components.
Common adverse reactions include loss of appetite, dry mouth, nausea, vomiting, abdominal pain, constipation, dyspepsia, flatulence, palpitations, tachycardia, increased blood pressure, etc. Serious adverse reactions include tremor, rigidity, urinary retention, urinary incontinence, prostatitis, sexual dysfunction, menstrual disorders, suicidal tendencies, chills to the extremities, etc. Rare adverse reactions include liver damage, seizures, closed-angle glaucoma, Raynaud’s disease etc.
Psychological and behavioral treatment
Commonly used behavioral treatments include reinforcement, shaping, abatement, and punishment. To promote the emergence of appropriate behaviors and reduce undesirable behaviors. In addition, attention should be paid to the establishment of a normal family structure and the development of self-control.
Parents who encounter problems in the treatment of their ADHD children can leave me a message online, and those who need in-depth communication can choose to contact me by telephone consultation.