A Consumer Reports Health survey finds 67 percent of parents asked to rate the most effective treatments for ADHD identified drug therapy as most helpful, followed by 45 percent who said switching to a school better suited to help with the condition helped a lot.
The report provides detailed guidance on two classes of drugs to treat ADHD (stimulants and non-stimulants). In a related blog, Consumer Reports' medical adviser, Dr. Orly Avitzur, discusses how the ADHD label has evolved, as evidenced by the small fraction of parents -- only 22 percent -- who said it was problematic having a child labeled as having ADHD.
"The result is that students and surprisingly professionals in several fields, including medicine, are seeking out an ADHD diagnosis in order to excel through the use of drugs or accommodations, such as more time to take tests," said Dr. Avitzur. Eight percent of parents whose kids had received a diagnosis told Consumer Reports Health that getting accommodations for standardized tests, like the SAT., was a reason for seeking an ADHD diagnosis.
ADHD treatments
Consumer Reports Health found that most families with children with ADHD turn to medication -- a full 84 percent put them to use at some point -- with more than half of the kids in the survey trying two or more medications in the past three years. The average age of children who tried ADHD drugs was 13 years. Many children with ADHD, including those who are not treated, improve as they progress into their teenage years and into their 20s.
According to parents surveyed, children who tried medications had slightly better outcomes than those not trying medications. Medication helped the most with academic performance and behavior at school. Medication was less helpful with behavior at home, social relationships, and self esteem.
And while medication was cited as the strategy most helpful in managing ADHD, only 52 percent of parents agreed strongly that if they had to do it over again, they would have their kids take medications and 44 percent wished there was another way to help their child.
Consumer Reports Best Buy Drugs, a public education project that rates prescription drugs for more than 20 common conditions based on safety, efficacy, and cost, identifies the two main classes of medications that are available for ADHD. Stimulant medications, which include amphetamine and methylphenidate-based medications, are generally considered the first line of medical treatment for a typical child with ADHD. Children who do not respond well to stimulants, and those with co-occuring conditions such as tics or anxiety, are candidates for nonstimulant medications such as atomoxetine (Strattera) or guanfacine (Intuniv).
While medications can help children concentrate, feel calmer, and think before acting, ADHD medication side effects are considerable in number and frequency. The most prevalent side effects, in descending order, include decreased appetite, sleep problems, weight loss, upset stomach, and irritability.
Of all the treatments, 35 percent of parents said medication helped the most when it comes to academic performance and behavior at school. Medication helped well with behavior at home (was very helpful for 26 percent) and fairly well with social relationships (very helpful for 19 percent) and self esteem (very helpful for 18 percent).
Team approach
Parents told Consumer Reports Health that nondrug strategies (such as changing the child's school) also worked very well. Leading strategies for handling ADHD include:
• Switching to a school better suited to help with ADHD helped 45 percent.
• Giving one instruction at a time helped 39 percent.
• Having a private tutor or learning specialist work with the child helped 37 percent.
• Providing structure by maintaining a schedule of activities helped 35 percent.
Most children (58 percent) had seen two or more treatment providers in the last 12 months. Given that each provider may have strengths in different areas, visiting more than one practitioner may help some families achieve better results. The parent's role as coordinator of care is critical.
Consumer Reports Health suggests these steps for coordinating care:
• Obtain copies of any medical, psychological, and testing records related to your child's ADHD condition. The more information you can provide to new treatment providers, the better.
• When enlisting a new professional to help your child, request a baseline measure of your child's behavior and functioning. This is an important step for three reasons: It provides an objective indication of a child's diagnosis that parents can bring to schools or other places as proof of diagnosis; it helps professionals know that tests have been previously administered and may save time and money; and it allows parents and treatment providers to monitor a child's progress from the beginning of treatment.
• Keep a list of all treatment providers who have worked with your child.
• Maintain a list of all the strategies you've tried and the changes you detected as a result.
• Explore an ADHD treatment center (where different types of providers work together at the same location) if you are unable to take on the role of coordinator of your child's treatment.
