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Understanding ADHD
Understanding ADHD

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2.2 Approaches to managing ADHD

There are a range of approaches to managing ADHD, and the exact approach taken will depend on factors such as access to treatments or interventions, culture and personal choice. Not all individuals with ADHD, or their parents, will want to manage or treat the condition. However, consequences of ADHD are far-reaching. You learnt in Session 1 that those with ADHD have a greater risk of learning, behavioural and emotional problems, and may struggle with social interactions. They also tend to have poorer performance at school and in the workplace (Doggett, 2004). These consequences mean that management of ADHD is a well-established area.

To better understand the range of approaches that are available, this section will look at the guidelines provided by the National Institute for Health and Care Excellence (NICE), a public body that provides national guidance in England. It is important to keep in mind that approaches in other countries, including other areas of the UK, may vary from what is described here.

Figure 12 provides a simplified overview of the NICE guidelines for the management of ADHD. From this figure you should see that for each age group there are several options. The guidelines specify the order in which the approaches should be taken. For example, for preschool children (under 5 years) the first approach should be parent training. An individual will only progress to the next stage if symptoms persist after the intervention or if, as may be the case for medication, the intervention is refused.

The diagram has three pathways. For preschool children the first approach is parent training, followed by personalised psychosocial interventions and finally medication. For children and young people the first approach is parent support and teacher training, then medication and finally psychological intervention e.g. CBT. For adults the steps are medication and then finally psychological intervention e.g. CBT. The pink shaded boxes are parent training, psychological intervention e.g. CBT, and medication.
Figure 12 NICE guidelines for the management of ADHD. Notice that approach taken varies by age with children divided into preschool (under 5 years) and older. The pink shaded boxes indicate the approaches we will examine in some detail.
  • What do you notice about the use of medication in the different age groups?

  • This approach is the last resort for preschool children but the first resort for adults.

The more cautious approach taken with medication in children reflects one of the unknowns about the medication, that is, it's unclear what long-term effects the medication can have in very young children, particularly in terms of growth and development.

Although Figure 12 shows single labels such as ‘parent training’ and ‘medication’ there are multiple different kinds of training or medication available. For example, medication for the condition can use either stimulant or non-stimulant drugs.