How is attention deficit hyperactivity disorder (adhd) typically treated?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological disorder and is marked by a pattern of hyperactivity, inability to focus on simple tasks and/or impulsive behaviour. This condition typically affects young children and teenagers but can also continue into adulthood.

Currently, there is no known cure for ADHD but there are plenty of options that can help your child manage the symptoms. Dr Leo Hamilton from Children’s Clinic International breaks down the various therapeutic options available in Singapore to manage ADHD in children. The most common is medications, primarily one form of methylphenidate. Medications, however, are not always the best choice, especially in younger children; in such cases, counselling and behavioural therapies can also help.

Medications to Manage ADHD

Methylphenidate is a long-established and probably the best-known treatment. It has many different forms, from the classic short-acting Ritalin to forms that can last about 8 to 14 hours.

What is Ritalin?

Ritalin, a short-acting methylphenidate (i.e. its effect only lasts for a short timeframe) is not as commonly used as it was years ago because it only lasts 4-6 hours. Due to its short duration of action, most children would need another dose of the medication at school, which is not only time-consuming but also a potential social stigma for children to have to see the nurse all the time.

Nowadays, it is more common to use an 8-hour formulation (Medikinet and Ritalin SR are the two brands available in Singapore). This ensures a single dose in the morning can at least last a full school day.

The longest-lasting forms of methylphenidate can last up to 14 hours (Concerta and Ritalin LA are the most common brands used in Singapore). These are helpful for older children and teenagers who need help focusing on homework, or impulse control in social situations. Often, children who have difficulty with family and friends because of ADHD benefit from a longer-lasting medication that typically lasts until bedtime.

Longer-acting formulations can reduce the frequency in between doses, minimising the impact on school-going children

Other ADHD Medications

Singapore is still limited in the range of ADHD medications available. There are commonly used medications like Adderall and Focalin in other countries that are not currently available here.

Apart from methylphenidate, the only other medicine approved and available in Singapore is atomoxetine (Strattera). This option is useful if the stimulant properties of methylphenidate cause problems, especially in children with a tic disorder or who have a significant appetite or sleep problems with methylphenidate.

Psychological Therapy or Counselling for ADHD in Children

Medications are not always the first or best choice in managing ADHD in children. Younger children aged 5-8 years old, often do better with counselling and behavioural therapies. Medications are only recommended if therapy fails. Even for older children, therapy may help with coping mechanisms and this makes medication unnecessary.

If your child is on medication, therapy can act as a supplement and can help your child regardless of age. In fact, it is recommended for older children and teenagers to see a psychologist.  Ultimately, the goal is to learn to cope and acquire studying strategies so that as your child gets older, he/she can adapt to work with ADHD and not need daily medications.

It is always recommended to tell the school about your child’s ADHD diagnosis. Many schools have special resources and accommodations (especially when taking tests or examinations) that can help students.

Family counselling can help as well, mainly if behavioural issues are present that causes stress to the whole family.

Psychological Therapy or Counselling for ADHD in Children

This is a slightly different approach. In behavioural therapy, parents are trained to use special strategies that would elicit the desired behaviour in their child. It is important to note when a child has ADHD, they often feel like they are always doing the wrong thing or what they are doing is not good enough. This method helps your child feel successful and supported in what they are doing.

In this method, good behaviour and correct actions are rewarded. Parents are also required to give feedback as much as possible to encourage their child; focusing on the positive is paramount. This aids in fostering your child’s confidence and competence in most tasks. 

Talk to Your Paediatrician

There are many options for ADHD treatment, and no one way works for everyone. Sometimes, a multidisciplinary approach works best. If you believe your child may have ADHD, contact your paediatrician. There are well-established ways to confirm ADHD (mainly written questionnaires for teachers and parents). Blood testing and imaging (EEGs or MRIs) are rarely helpful and not part of the standard evaluation.

If you do have concerns, the first and foremost step you should take is talking to your doctor.

About Author This article is written by Dr Leo Hamilton, who is a US board-certified Paediatrician since 2003. Dr Leo relocated to Singapore in 2011, caring for expat and Singaporean children from newborns at delivery to teenagers. Beyond his background in Hematology/Oncology, he has an interest in asthma, behavioural issues (primarily ADHD), teen health, and modern management of routine childhood illnesses such as ear infections, bronchiolitis, and pneumonia.

What is the most effective method for treating ADHD?

The research is clear: ADHD medication paired with behavioral therapy is the most effective treatment for attention deficit hyperactivity disorder (ADHD) in children — particularly those who also exhibit oppositional behavior.

How is ADHD diagnosed and treated?

If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare provider to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician.