Attention-deficit hyperactivity disorder behavioral therapy

Pharmacotherapy is superior to behavioral therapy in the treatment of attention-deficit hyperactivity disorder. Behavior modification provided by parents and teachers in conjunction with pharmacotherapy improves treatment outcomes more than behavior therapy alone. 

Stimulants. A handful of case reports hint that treatment with stimulants (meth-ylphenidate or dextroamphetamine) can help manage behavioral agitation in patients who have suffered a TBI. Certainly, stimulant therapy helps control the impulsivity and hyperactivity of children with attention deficit-hyperactivity disorder. Despite these encouraging signs, we have to discourage any routine use of stimulants when attempting to manage behavioral lability in TBI patients. Because stimulants have the potential to exacerbate behavioral lability, we recommend that they only be considered when other medication alternatives have been exhausted. 

Hinshaw, S.P. and Erhardt, D.E. (1991) Attention-deficit hyperactivity disorder. In Kendall, P.C., ed. Child and Adolescent Therapy. Cognitive-Behavioral Procedures. New York Guilford Press pp. 98-130. 

Suicidal ideation in Child and Adolescents—STRATTERA (atomoxetine) increased the risk of suicidal ideation in short-term studies in children or adolescents with Attention-Deficit Hyperactivity Disorder (ADHD). Anyone considering the use of STRATTERA in a child or adolescent must balance this risk with the clinical needs. Patients who are started on therapy should be monitored closely for suicidality (suicidal thinking and behavior), clinical worsening, or unusual changes in behavior. 

Nervous system Clonidine has been successfully used for impulsive and oppositional behavior in attention-deficit hyperactivity disorder as well as for its centrally mediated sedative action when taken late in the day. A child who took clonidine for this indication had night terrors shortly after initial therapy, insomnia during attempts at drug withdrawal, and depression when the drug was finally tapered and stopped... 

Attention deficit disorder (ADD) in children is characterized by short attention span, restlessness, distractibility, impulsivity and emotional lability. Hyperactivity is sometimes associated. Amphetaminelike drugs reduce these symptoms in >80% of affected children (Table 3.2). Many treatment plans also involve family counseling and/or psychotherapy. Therapy is usually tailored around the school schedule, the goal being to enhance school performance and encourage behavior which is suitable for the classroom. Drug therapy is often discontinued during school vacations. 

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