ADHD, with or without hyperactivity, is managed in a multidisciplinary way in adults and children.
Management of ADHD in children
Non-pharmacological measures
In children, the focus is first on non-pharmacological measures: making educational and psychological adaptations for the child and those around them, parent training (what’s known as the “Barkley” method), adjustments at school as well as psychological and educational measures.
Management of other potential neurodevelopmental disorders
If needed, other neurodevelopmental disorders can also be managed: autism spectrum disorders, specific learning difficulties (dyslexia, dysgraphia, dyscalculia, dyspraxia, etc.), which are more common in children with ADHD and can aggravate its functional impact if not correctly managed.
Treatment with medication
Treatment with medication can be a secondary option if non-pharmacological measures have not worked or there is not sufficient improvement. The first-line treatment in France is methylphenidate, better known as Ritalin.
Management of ADHD in adults
Treatment with medication
In adults, the first-line treatment is prescribing PR methylphenidate (PR stands for prolonged release), for which different pharmacokinetic profiles exist, adapted according to the patient, efficacy, tolerance, and needs.
Management of comorbidities
Management of comorbidities must also be a consideration, especially if the following are identified:
- depressive episodes,
- chronic mood disorders (unipolar or bipolar),
- anxiety disorders
- other neurodevelopmental disorders (depending on current recommendations).
Managing ADHD optimally requires consideration and treatment of any comorbidity, however closely related, and should not be overlooked.
Psychotherapy
Cognitive behavioral therapy (CBT), as a type of psychotherapy, is often focused on patients’ specific difficulties, as well as psychological management of ADHD in the long term. For that reason, psychoeducational measures and support are also usually put in place.
What are the effects of methylphenidate (Ritalin)?
Methylphenidate’s mode of action
Methylphenidate or Ritalin is an amphetamine-like treatment that primarily acts on dopamine and noradrenaline-mediated. In ADHD, the physiology of these neurotransmitters is thought to be altered.
The expected effects are a temporary improvement in cognitive capacities, particularly attention. It has effects on other elements of the disorder, but to a lesser extent.
Side effects of methylphenidate
Methylphenidate has side effects such as anxiety and sleep problems. There is a risk of a manic episode, which can be observed in some patients with ADHD-linked bipolar disorder, but the frequency and severity of this are still debated.
The existence of these psychological side effects underscore the importance of early diagnosis of comorbidities by a trained physician.
Methylphenidate is also cardiotropic (in other words, it can have effects on the heart and its functioning). It is therefore recommended that any cardiological contraindications are ruled out before prescription. This test is usually performed by a cardiologist.
There is also a risk of addiction and misuse of methylphenidate, which is also classified on the list of narcotics. Prescribing methylphenidate is therefore strictly controlled and the dosage and indication must be regularly reviewed.
It is common for patients to stop taking methylphenidate on days when their attentional performance is not required (vacations, public holidays, weekends), without this having any effect on the long-term progression of the disorder in adults.
Alternatives to methylphenidate
There are second-line molecules, although they are rarely prescribed when methylphenidate is contraindicated. These molecules (atomoxetine, guanfancine, lisdexamfetamine) have low efficacy and poor tolerance. They should only be prescribed in very specific cases, and only by physicians who specialize in the management of ADHD.
