Abstract
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. It is the most common neurodevelopmental disorder presenting to pediatric services, and pediatricians are often involved in the early assessment, diagnosis, and treatment of children with ADHD. The treatment of ADHD typically involves a multimodal approach that encompasses a combination of psychoeducation, parent/teacher training, psychosocial/psychotherapeutic interventions, and pharmacotherapy. Concerning pharmacotherapy, guidelines vary in drug choice and sequencing, with psychostimulants, such as methylphenidate and (lis)dexamfetamine, generally being the favored initial treatment. Alternatives include atomoxetine and guanfacine. Pharmacotherapy has been proven effective, but close follow-up focusing on physical growth, cardiovascular monitoring, and the surveillance of potential side effects including tics, mood fluctuations, and psychotic symptoms, is essential. This paper presents an overview of current pharmacological treatment options for ADHD and explores disparities in treatment guidelines across different European countries.
Conclusion: Pharmacological treatment options for ADHD in children and adolescents are effective and generally well-tolerated. Pharmacotherapy for ADHD is always part of a multimodal approach. While there is a considerable consensus among European guidelines on pharmacotherapy for ADHD, notable differences exist, particularly concerning the selection and sequencing of various medications.
What is Known: • There is a significant base of evidence for pharmacological treatment for ADHD in children and adolescents. • Pediatricians are often involved in assessment, diagnosis and management of children with ADHD. |
What is New: • Our overview of different European guidelines reveals significant agreement in the context of pharmacotherapy for ADHD in children and adolescents. • Discrepancies exist primarily in terms of selection and sequencing of different medications. |
Similar content being viewed by others
Change history
26 January 2024
A Correction to this paper has been published: https://doi.org/10.1007/s00431-024-05426-5
References
Association AP (2013) Diagnostic and statistical manual of mental disorders, 5th edn
Willcutt EG (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9(3):490–499
Reale L, Bartoli B, Cartabia M, Zanetti M, Costantino MA, Canevini MP et al (2017) Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry 26(12):1443–1457
Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA et al (2021) The World Federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev 128:789–818
Able SL, Johnston JA, Adler LA, Swindle RW (2007) Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychol Med 37(1):97–107
Chen VC, Chan HL, Wu SI, Lee M, Lu ML, Liang HY et al (2019) Attention-deficit/hyperactivity disorder and mortality risk in Taiwan. JAMA Netw Open 2(8):e198714
Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB, Pedersen MG (2015) Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet 385(9983):2190–2196
Gezondheidsraad H (2021) Medicamenteuze en niet-medicamenteuze aanpak van ADHD (ADVIES nr. 9547). Brussels, Belgium
GGZ Standaarden (2019) Zorgstandaard ADHD. Amsterdam, the Netherlands
Sundhedsstyrelsen (2021) Udredning og behandling af ADHD hos børn og unge. Denmark
National Institute for Health and Clinical Excellence (2018) Attention deficit hyperactivity disorder: diagnosis and management: update. UK
Ministerio de Sanidad, Servicios Sociales e Igualdad (2017) Guía de Práctica Clínica sobre las Intervenciones Terapéuticas en el Trastorno por Déficit de Atención con Hiperactividad (TDAH). Madrid, Spain
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2017) Long version of the interdisciplinary, evidence- and consensus-based (S3) guidelines “Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents and adults”. Germany
Storebo OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE et al (2023) Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 3(3):CD009885
Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S et al (2018) Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 5(9):727–738
Arnold LE (2000) Methylphenidate vs. amphetamine: comparative review. J Atten Disord 3(4):200–211
Carucci S, Balia C, Gagliano A, Lampis A, Buitelaar JK, Danckaerts M et al (2021) Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neurosci Biobehav Rev 120:509–525
Zhang H, Du M, Zhuang S (2010) Impact of long-term treatment of methylphenidate on height and weight of school age children with ADHD. Neuropediatrics 41(2):55–59
Man KKC, Hage A, Banaschewski T, Inglis SK, Buitelaar J, Carucci S et al (2023) Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. Lancet Psychiatry 10(5):323–333
Ibrahim K, Donyai P (2015) Drug holidays from ADHD medication: international experience over the past four decades. J Atten Disord 19(7):551–568
Zhang L, Yao H, Li L, Du Rietz E, Andell P, Garcia-Argibay M et al (2022) Risk of cardiovascular diseases associated with medications used in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. JAMA Netw Open 5(11):e2243597
Pierick AR, Lynn M, McCracken CM, Oster ME, Iannucci GJ (2021) Treatment of attention deficit/hyperactivity disorder in children with CHD. Cardiol Young 31(6):969–972
Trairatvorakul P, Meinzen-Derr J, Heydarian H, Mason K, Anixt JS (2023) Stimulant medication treatment in children with congenital heart disease and attention-deficit/hyperactivity disorder: cardiovascular outcomes. J Dev Behav Pediatr 44(4):e247–e254
Castellanos FX, Giedd JN, Elia J, Marsh WL, Ritchie GF, Hamburger SD et al (1997) Controlled stimulant treatment of ADHD and comorbid Tourette’s syndrome: effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry 36(5):589–596
Stuckelman ZD, Mulqueen JM, Ferracioli-Oda E, Cohen SC, Coughlin CG, Leckman JF et al (2017) Risk of irritability with psychostimulant treatment in children with ADHD: a meta-analysis. J Clin Psychiatry 78(6):e648–e655
Man KK, Coghill D, Chan EW, Lau WC, Hollis C, Liddle E et al (2016) Methylphenidate and the risk of psychotic disorders and hallucinations in children and adolescents in a large health system. Transl Psychiatry 6(11):e956
Man KKC, Coghill D, Chan EW, Lau WCY, Hollis C, Liddle E et al (2017) Association of risk of suicide attempts with methylphenidate treatment. JAMA Psychiat 74(10):1048–1055
Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD (2015) Stimulant medications and sleep for youth with ADHD: a meta-analysis. Pediatrics 136(6):1144–1153
Faraone SV, Po MD, Komolova M, Cortese S (2019) Sleep-associated adverse events during methylphenidate treatment of attention-deficit/hyperactivity disorder: a meta-analysis. J Clin Psychiatry 80(3)
Carlson GA, Kelly KL (2003) Stimulant rebound: how common is it and what does it mean? J Child Adolesc Psychopharmacol 13(2):137–142
Morton WA, Stockton GG (2000) Methylphenidate abuse and psychiatric side effects. Prim Care Companion J Clin Psychiatry 2(5):159–164
McCabe SE, West BT, Teter CJ, Boyd CJ (2014) Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots. Addict Behav 39(7):1176–1182
Wilens TE, Faraone SV, Biederman J, Gunawardene S (2003) Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111(1):179–185
Chamakalayil S, Strasser J, Vogel M, Brand S, Walter M, Dursteler KM (2020) Methylphenidate for attention-deficit and hyperactivity disorder in adult patients with substance use disorders: good clinical practice. Front Psychiatry 11:540837
Faraone SV (2009) Using meta-analysis to compare the efficacy of medications for attention-deficit/hyperactivity disorder in youths. P T 34(12):678–694
Cerrillo-Urbina AJ, Garcia-Hermoso A, Pardo-Guijarro MJ, Sanchez-Lopez M, Santos-Gomez JL, Martinez-Vizcaino V (2018) The effects of long-acting stimulant and nonstimulant medications in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials. J Child Adolesc Psychopharmacol 28(8):494–507
Ahmed R, Aslani P (2013) Attention-deficit/hyperactivity disorder: an update on medication adherence and persistence in children, adolescents and adults. Expert Rev Pharmacoecon Outcomes Res 13(6):791–815
Volkow ND, Swanson JM (2003) Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. Am J Psychiatry 160(11):1909–1918
Lopez FA, Leroux JR (2013) Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: a focus on extended-release formulations and the prodrug lisdexamfetamine dimesylate to address continuing clinical challenges. Atten Defic Hyperact Disord 5(3):249–265
Ermer JC, Pennick M, Frick G (2016) Lisdexamfetamine dimesylate: prodrug delivery, amphetamine exposure and duration of efficacy. Clin Drug Investig 36(5):341–356
Patrick KS, Caldwell RW, Ferris RM, Breese GR (1987) Pharmacology of the enantiomers of threo-methylphenidate. J Pharmacol Exp Ther 241(1):152–158
Sauer JM, Ring BJ, Witcher JW (2005) Clinical pharmacokinetics of atomoxetine. Clin Pharmacokinet 44(6):571–590
Bangs ME, Wietecha LA, Wang S, Buchanan AS, Kelsey DK (2014) Meta-analysis of suicide-related behavior or ideation in child, adolescent, and adult patients treated with atomoxetine. J Child Adolesc Psychopharmacol 24(8):426–434
Clavenna A, Bonati M (2017) Pediatric pharmacoepidemiology - safety and effectiveness of medicines for ADHD. Expert Opin Drug Saf 16(12):1335–1345
Reed VA, Buitelaar JK, Anand E, Day KA, Treuer T, Upadhyaya HP et al (2016) The safety of atomoxetine for the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a comprehensive review of over a decade of research. CNS Drugs 30(7):603–628
Camporeale A, Day KA, Ruff D, Arsenault J, Williams D, Kelsey DK (2013) Profile of sexual and genitourinary treatment-emergent adverse events associated with atomoxetine treatment: a pooled analysis. Drug Saf 36(8):663–671
Alamo C, Lopez-Munoz F, Sanchez-Garcia J (2016) Mechanism of action of guanfacine: a postsynaptic differential approach to the treatment of attention deficit hyperactivity disorder (adhd). Actas Esp Psiquiatr 44(3):107–112
Mechler K, Banaschewski T, Hohmann S, Hage A (2022) Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacol Ther 230:107940
Author information
Authors and Affiliations
Contributions
L.V.V. and B.D. wrote the manuscript. All other authors reviewed and revised the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Communicated by Peter de Winter
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The original online version of this article was revised: The author name B. Koch has been presented in full name.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Van Vyve, L., Dierckx, B., Lim, C.G. et al. Pharmacotherapy for ADHD in children and adolescents: A summary and overview of different European guidelines. Eur J Pediatr 183, 1047–1056 (2024). https://doi.org/10.1007/s00431-023-05370-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-023-05370-w