Recent Progress in Psychosocial and Psychopharmacologic Treatments for ADHD

Abstract

In this article, we review several new psychosocial and psychopharmacologic treatment approaches for attention deficit hyperactivity disorder (ADHD). Several of the treatments reviewed are promising and offer opportunities for augmenting current evidence-based approaches. However, others are not yet ready for prime time. Consequently, existing algorithms for ADHD treatment should still be followed. Current guidelines include those from the American Academy of Pediatrics (Wolraich et al. Pediatrics. 128 5:1007–22 2011), the American Academy of Child and Adolescent Psychiatry (AACAP) (Pliszka S and AACAP Work Group on Quality Issues. J Am Acad Child Adolesc Psychiatry. 46 7:894–921 2007), and the Texas Department of Mental Health and Mental Retardation (Pliszka et al. J Am Acad Child Adolesc Psychiatry. 45 6:642–57 2006). These treatment recommendations and algorithms are based on results from both controlled clinical trials and expert opinion. For core symptoms, medication is considered superior to psychosocial treatment. However, the full range of ADHD-associated impairments is best addressed by combined treatment, with an emphasis on behavioral interventions as first-line approaches when treating preschool children with ADHD. The availability of an evidence-based organizational skills training program is a welcome addition for targeting problems with organization and attention-related impairments in children. Among available medication treatments, stimulants are considered to have the most robust effects on core symptoms; however several non-stimulant medications are available and others are being investigated for possible utility. Combined pharmacotherapy with stimulants and α2 agonists is now an FDA-approved treatment and can be considered in youth who are not fully responsive to stimulants or who have other problems which may represent indications for α2 agonist treatment. Combined treatment with stimulants plus risperidone has merit in youth with severe aggressive behavior but remains off-label and should generally be considered when other options fail. The potential risk and benefits of stimulant treatment for subsequent substance abuse remains an important topic. In the main, stimulant treatment is considered safe and may even provide protection against development of substance abuse. However, the possibility that stimulant exposure could be problematic in youth with elevated risk for substance abuse disorders should be considered.