Primary care plays a key role in the management of
ADHD
Discussing the future
Approximately 20% of children may be able to discontinue medication after about a year of treatment
Because of this, a period off medication should be trialled annually to determine if there is a continuing need for it. These trials need to occur during school term so that response at school as well as at home can be assessed. However the start of the school year is not a good time as it is often stressful and examination times should also be avoided. Trial periods only need to be from a few days to a fortnight and medication can be resumed if problems return.
The majority of children with ADHD continue to display symptoms into adolescence
The teen years are challenging for most people and often more so for adolescents with ADHD. Hyperactivity frequently becomes less visible but other symptoms of ADHD, particularly impulsivity, can place extra demands on young people coping with increasing physical, social and psychological challenges.
Academic problems become more noticeable as cognitive demands increase and students are expected to become more independent of supervision. The routine ups and downs of daily life can result in excessive highs and lows coupled with low thresholds for frustration and anger. These problems are often compounded by poor adherence to treatments as teenagers learn to make their own decisions.
Comorbid conditions may complicate the situation. Mood disorders in adolescents with ADHD demand careful assessment of self-injury or life threatening behaviours. Adolescents with ADHD are at increased risk of substance abuse and unlawful activity although some of this risk can be offset by continuation of treatment with stimulant medication.
Wolraich et al review the diagnosis, treatment and implications for people in this age group with ADHD.6
At least half of children with ADHD will carry some symptoms into adult life
These symptoms are not necessarily negative and can often help achieve success. Energy, risk taking and the ability to see things from a different point of view can lead to great accomplishments. Richard Branson, Bono and Steve Jobs, the inventor of the iPod are all apparently on record as acknowledging they have ADHD.
Adolescents with ADHD need skilled and supportive guidance. They cannot be forced into unsuitable career paths or lifestyles but, if they are helped to gain insight into the disorder and its effect on their life, most will find satisfying careers and lifestyles to which they can bring energy, warmth and boundless enthusiasm.
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