There is no cure for attention deficit hyperactivity disorder, but it can be managed using on the central nervous system stimulants methylphenidate, atomoxetine or dexamfetamine.

Dosage regimen

* Atomoxetine is taken once a day.

* Dexamfetamine is taken in divided doses throughout the day.

* Methylphenidate is taken once or twice a day.

Patient's knowledge of the medicine's use

* Methylphenidate helps improve concentration and reduce impulsive behaviour.

* Atomoxetine helps improve concentration, and self-esteem.

* Dexamfetamine is used when other drugs have failed to produce an effect.

Is the medicine working?

* Low doses are used initially. If these do not work, the dose is increased by weekly intervals. This is continued until an effect is seen.

* The effect of methylphenidate can wear off by the evening, and cause rebound hyperactivity. If this occurs, the dose may be taken at bedtime instead.

Side effects

* Methylphenidate and atomoxetine commonly cause nervousness, insomnia, headache, decreased appetite and gastrointestinal symptoms.

* Dexamfetamine commonly causes irritability, nausea, and decreased appetite.

Monitoring

* Atomoxetine can cause hepatic disorders. Patients and carers should be advised to seek medical attention if any of the following develops: jaundice, malaise, abdominal pain, darkened urine, or unexplained nausea.

* Atomoxetine can also cause suicidal ideation. Medical help should be sought if the child becomes depressed or irritable.

* Dexamfetamine: height, weight (long term use can slow growth), and blood pressure should be checked regularly.

* Methylphenidate: full blood counts, growth and blood pressure should be regularly monitored.

Lifestyle

* The Webster-Stratton training programme can help reduce impulsive behaviour. This programme teaches parents how to alter a childs behaviour. More information is available at www.incredibleyears.com.

* Encourage the child to exercise as this can help burn off excess energy.

* Supplements containing DHA (docosahexaenoic acid), eicosapentanoic acid and gamma linolenic acid can help reduce impulsiveness, hyperactivity and inattention.

* ADHD patients should be advised to stick to a healthy diet, avoiding processed foods, additives, colourants and fizzy drinks.

Uzma Chaudhry, relief pharmacist, Lloydspharmacy, Oxfordshire

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