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Thursday, April 17, 2014
Attention Deficit Hyperactivity Disorder
Medication for ADD
Is there a medication that can be used for ADD if a person has stereotypical behaviors or tics? A trial of Strattera was already done and it did not help.
Evidence has been published that, compared to stimulants, which can cause or worsen tics in some cases, atomoxetine (Strattera) can actually help tics in some cases and seems not to worsen them. But there are individual cases where atomoxetine does not help.
A much better established treatment for tics is guanfacine (Tenex), which also helps ADHD symptoms. Clonidine (Catapres), a similar drug in the same class, has similar action, but more side effects (sedation) and shorter half-life so that it has to be taken 4 times a day. Therefore guanfacine, with a long duration of effect and less sedation, is gradually replacing clonidine for daytime treatment of ADHD and tics.
Another class of drugs with proven efficacy for tics and somewhat for ADHD is the antipsychotics, such as haloperidol (old type) and risperidone (newer "atypical" type). These could have serious side effects such as excessive weight gain or tardive dyskinesia.
Further information about medication and other treatments for ADHD can be found in my "Family Guide to ADHD", Handbooks in Health Care, Newtown, PA (http://www.hhcbooks.com/).
Because all medicines can have side effects and tend to work for tics and/or ADHD only while they are given, investigators have been exploring other treatments for each disorder. For example, a Yale group (with Larry Scahill) has shown significant benefit for tics from cognitive-behavioral treatment.
Here at OSU we will be starting a study of EEG neurofeedback for 6-12-year-old children with ADHD this fall (Lauren Pinto, 688-3848 for details), and a study of exercise compared to medication for 6-8 year old children with ADHD and reading delay.
L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University