ADHD - oversikt: Behandling
Formål
- Gi informasjon til barnet, ungdommen eller den voksne, til foreldre, nære familie, skole/barnehage eller jobb om vanskelighetene som finnes, men også om sterke sider som bør utnyttes
- Legge til rette for en best mulig utvikling fremover, hindre mistrivsel og uheldige atferdsmønster hos barn
- Redusere symptomer for å bedre mulighetene for læring, få frem ubrukte ressurser, og skape bedre forhold til foreldre og kamerater
- Bedre fungering i hverdagen, trivsel og mestring
Psykososiale tiltak
Informasjon, rådgiving, tilrettelegging og støtte til familie og miljøet rundt, er blant de viktigste tiltakene. Eksempler på dette kan være:
- Hjelp til å strukturere hverdagen på en bedre måte. Det er viktig å skape oversikt, forutsigbarhet og kontinuitet i omsorgen og den pedagogiske situasjonen. Hjelpemidler som påminnelser på smarttelefon eller smartklokke, kan være av god nytte
- Hjelp til bedre sosial fungering og redusere konflikter (for eksempel i friminutter)
- Støtte og avlastningstiltak som besøkshjem
Medikamentell behandling
Legemiddelbehandling gis dersom det foreligger en alvorlig funksjonsnedsettelse. Legemidler skal gis som del av et mer omfattende behandlingsprogram, ikke som eneste behandling. Behandlingen er rettet mot hyperaktivitet, impulsivitet og konsentrasjonsproblemer. Bedring av disse symptomene kan også virke gunstig på andre vansker.
Sentralstimulerende midler som metylfenidat er mest brukt, og kan redusere symptomer hos opptil tre av fire barn som får behandling. Effekten hos voksne er ikke like godt studert, og ser ut til å være noe mindre. Vi har ennå ikke gode data på hvordan virkning og bivirkninger er over tid.
Behandling med sentralstimulerende midler skal startes og styres av barnelege, barnepsykiater, psykiater, nevrolog eller spesialist i rus- og avhengighetsmedisin. Oppfølgingen kan etterhvert overføres til fastlegen. Oppfølging med vurdering av effekt og mulige bivirkninger blir viktig. Det anbefales et årlig forsøk med en periode uten medisin, for å se om medisinen fortsatt virker eller fortsatt er nødvendig.
Sentralstimulerende kan lindre symptomer ved ADHD, men de helbreder ikke tilstanden.
Psykoterapi
- Rådgivning, veiledning og trening av foreldre om hvordan forholde seg til barnet ("Foreldreskoler")
- Psykoterapi i forhold til ledsagende problemer som måtte oppstå
- Behandling som påvirker atferden
- Stimulering/forsterkning av ønsket atferd
- Nødvendig å arbeide med små forandringer - en ting om gangen
- Detaljert planlegging
- Gode belønninger
Kost
Det er mye fokus på kosthold, men med dagens kunnskap kan man ikke anbefale noen spesiell diett.
Les mer om ADHD, behandling.
Vil du vite mer
- ADHD, symptomer og tegn
- ADD versus ADHD - hva er forskjellen?
- ADHD, årsaker
- ADHD, diagnostikk
- ADHD, når bør vi kontakte lege?
- ADHD, behandling
- ADHD, tips til foreldrene
- ADHD, komplikasjoner
- ADHD, mestringsteknikker for foreldrene
- ADHD, animasjon
- Intervju om å leve med tics, Tourettes, ADHD og tvangslidelser
- ADHD Norge, interesseorganisasjon
Dette dokumentet er basert på det profesjonelle dokumentet ADHD/hyperkinetisk forstyrrelse . Referanselisten for dette dokumentet vises nedenfor
- ADHD/hyperkinetisk forstyrrelse - Nasjonal faglig retningslinje for utredning, behandling og oppfølging. Helsedirektoratet. Sist faglig oppdatert: 01. april 2022. www.helsedirektoratet.no
- Zeiner P, Weidle B. Hyperkinetiske forstyrrelser. Veileder i BUP. Norsk barne- og ungdomspsykiatrisk forening, 4. utgave. 2019. beta.legeforeningen.no
- Surén P, Thorstensen AG, Tørstad M et al. Diagnostikk av hyperkinetisk forstyrrelse hos barn i Norge. Tidsskr Nor Legeforen 2018. doi:10.4045/tidsskr.18.0418 DOI
- Heiervang E, Stormark KM, Lundervold AJ, Heimann M, Goodman R, Posserud MB, et al. Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry 2007;46(4):438-47. PubMed
- Bøe T, Heiervang ER, Stormark KM et al. Prevalence of psychiatric disorders in Norwegian 10-14-year-olds: Results from a cross-sectional study. PLoS One. 2021 Mar 19;16(3):e0248864. PMID: 33740026 PubMed
- Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH: Prevalence of psychiatric disorders in preschoolers. Journal of Child Psychology and psychiatry 2012; 53 (6) 695-705. pmid: 22211517 PubMed
- Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012 Jul;9(3):490-9. PMID: 22976615 PubMed
- Young S, Adamo N, Ásgeirsdóttir BBet al. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020 Aug 12;20(1):404. PMID: 32787804 PubMed
- Demontis D, Walters RK, Martin J et al; ADHD Working Group of the Psychiatric Genomics Consortium (PGC); Early Lifecourse & Genetic Epidemiology (EAGLE) Consortium. Nat Genet. 2019 Jan;51(1):63-75. Epub 2018 Nov 26. PMID: 30478444 PubMed
- Cederlöf M, Ohlsson Gotby A, Larsson H et al. Klinefelter syndrome and risk of psychosis, autism and ADHD. J Psychiatr Res. 2014 Jan;48(1):128-30. Epub 2013 Oct 11. PMID: 24139812 PubMed
- Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Mol Psychiatry. 2019 Apr;24(4):562-575. Epub 2018 Jun 11. PMID: 29892054 PubMed
- Bélanger SA, Andrews D, Gray C, Korczak D. ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity. Paediatr Child Health. 2018 Nov;23(7):447-453. Epub 2018 Oct 24. PMID: 30681669 PubMed
- Faraone SV, Banaschewski T, Coghill D et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021 Sep;128:789-818. Epub 2021 Feb 4. PMID: 33549739 PubMed
- Hegvik TA, Instanes JT, Haavik J et al. Associations between attention-deficit/hyperactivity disorder and autoimmune diseases are modified by sex: a population-based cross-sectional study. Eur Child Adolesc Psychiatry. 2018 May;27(5):663-675. doi: 10.1007/s00787-017-1056-1. Epub 2017 Oct 5. Erratum in: Eur Child Adolesc Psychiatry. 2017 Dec 1;: PMID: 28983730 PubMed
- Thapar A, Cooper M, Eyre O, Langley K. Practitioner Review: What have we learnt about the causes of ADHD? J Child Psychol Psychiatry. 2013;54(1):3-16. PubMed
- Hoogman M, Bralten J, Hibar DP et al. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, Feb 2017. PMID: 28219628 PubMed
- Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet 2016; 387: 1240-50. pmid:26386541 PubMed
- Sciberras E, Mulraney M, Silva D, Coghill D. Prenatal Risk Factors and the Etiology of ADHD-Review of Existing Evidence. Curr Psychiatry Rep. 2017 Jan;19(1):1. PMID: 28091799 PubMed
- Ystrom E, Gustavson K, Brandlistuen RE, et al. Prenatal Exposure to Acetaminophen and Risk of ADHD. Pediatrics. 2017;140(5):e20163840. DOI: 10.1542/peds.2016-3840 DOI
- Ji Y, Azuine RE, Zhang Y, et al. Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. JAMA Psychiatry 2019. pmid:31664451 PubMed
- Ahlqvist VH, Sjöqvist H, Daman C, et al. Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. JAMA 2024; 331: 1205-1214. pmid:38592388 PubMed
- Christensen J, Pedersen LH, Sun Y et al. Association of Prenatal Exposure to Valproate and Other Antiepileptic Drugs With Risk for Attention-Deficit/Hyperactivity Disorder in Offspring. JAMA 2019; 2: e186606. doi:10.1001/jamanetworkopen.2018.6606 DOI
- Hernandez-Diaz S, Straub L, Bateman BT, et al. Risk of Autism after Prenatal Topiramate, Valproate, or Lamotrigine Exposure. N Engl J Med. 2024 Mar 21;390(12):1069-1079. PMID: 38507750 PubMed
- Keenan HT, Hall G, Marshall SW. Early head injury and attention deficit hyperactivity disorder: retospective cohort study. BMJ 2008; 337: a1984. pmid: 18988644 PubMed
- Gjevik E, Eldevik S, Fjæran-Granum T, Sponheim E. Kiddie-SADS reveals high rates of DSM-IV disorders in children and adolescents with autism spectrum disorders. J Autism Dev Disord. 2011;41(6):761-9. PubMed
- Tsang TW, Kohn MR, Efron D et al. Anxiety in Young People With ADHD: Clinical and Self-Report Outcomes. J Atten Disord 2012. pmid: 22713359 PubMed
- Wingo AP, Ghaemi SN. A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder. Clin psychiatry 2007; 68:1776-84 PubMed
- van de Glind G, Konstenius M, Koeter MW, et al. IASP Research Group. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug Alcohol Depend 2014;134:158-66 PubMed
- Van de Glind G, Brynte C, Skutle A, et al. The International Collaboration on ADHD and Substance Abuse (ICASA): Mission, Results, and Future Activities. Eur Addict Res. 2020;26(4-5):173-178. PMID: 32599579 PubMed
- NICE guidelines NG87 Attention deficit hyperactivity disorder: Diagnosis and management. (Publisert: March 2018). www.nice.org.uk
- Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review). Evid Based Child Health 2013 Mar 7;8(2):318-692. PubMed
- Amlund-Hagen K, Ogden T, Bjørnebekk G. Treatment outcomes and mediators of Parent Management Training: A one-year follow-up of children with conduct problems. J Clin Child Adolesc Psychology 2011; 40(2):1-14. PubMed
- Larsson B, Fossum S, Clifford G, Drugli MB, Handegård BH, Mørch WT. Treatment of oppositional defiant and conduct problems in young Norwegian children : results of a randomized controlled trial. Eur Child Adolesc Psychiatry. 2009 Jan;18(1):42-52. PubMed
- Hiscock H, Sciberras E, Mensah F, et al. Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial. BMJ 2015; 350: h68. pmid: 25646809 PubMed
- Haugan AJ, Sund AM, Young S et al. Cognitive behavioural group therapy as addition to psychoeducation and pharmacological treatment for adolescents with ADHD symptoms and related impairments: a randomised controlled trial. BMC Psychiatry. 2022 Jun 2;22(1):375. PMID: 35655149 PubMed
- Sonuga-Barke EJ, Brandeis D, Cortese S, et al; European ADHD Guidelines Group. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013 Mar 1;170(3):275-89. PubMed
- Baweja R, Mattison RE, Waxmonsky JG. Impact of Attention-Deficit Hyperactivity Disorder on School Performance: What are the Effects of Medication?. Paediatr Drugs 2015; 17: 459-77. pmid:26259966 PubMed
- Sundhedsstyrelsen. National klinisk retningslinje for utredning og behandling af ADHD hos børn og unge. 2020. app.magicapp.org
- Cortese S, Adamo N, Del Giovane C et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry 2018; 5: 727-738. pmid:30097390 PubMed
- Swanson JM, Arnold LE, Molina BSG et al. Young adult outcomes in the follow-up of the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder: symptom persistence, source discrepancy and height Suppression. J Child Psychol Psychiatry 2017; 58: 663-78. pmid:28295312 PubMed
- The MTA Cooperative Group. National Institute of Mental Health Multimodal treatment study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 2004; 113: 762-9. pmid: 15060225 PubMed
- Matthijssen AM, Dietrich A, Bierens M et al. Continued Benefits of Methylphenidate in ADHD After 2 Years in Clinical Practice: A Randomized Placebo-Controlled Discontinuation Study. Am J Psychiatry 2019. pmid:31109200 PubMed
- Zhang L, Li L, Andell P, et al. Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA Psychiatry. Published online November 22, 2023. PMID: 37991787. PubMed
- DMP. Eksempler på legemidler som er omfattet av Schengen-attestbestemmelsene i Norge. Sist oppdatert 05.09.2023. www.dmp.no
- Reseptregisteret. Folkehelseinstituttet. Søk 14.12.2021
- Storebo OJ, Storm MRO, Pereira Ribeiro J, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev. 2023 Mar 27;3(3):CD009885. doi: 10.1002/14651858.CD009885.pub3. DOI
- Storebø OJ, Pedersen N, Ramstad E et al. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non‐randomised studies. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD012069. DOI: 10.1002/14651858.CD012069.pub2. Accessed 13 December 2021. The Cochrane Library
- Kidwell HM, et al. Stimulant medications and sleep for youth with ADHD: A meta-analysis . Pediatrics 2015. pmid: 26598454 PubMed
- Man KKC, Häge A, Banaschewski T et al; ADDUCE Consortium. 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. 2023 May;10(5):323-333. Epub 2023 Mar 20. PMID: 36958362.
- Man KKC, Häge A, Banaschewski T, et al. 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. 2023;10(5):323-333. PubMed
- Shin J-Y, Roughead EE, Park B-J, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): Nationwide self controlled case series study. BMJ 2016; 353: i2550. pmid: 27245699 PubMed
- Viktorin A, Ryden E, Thase ME, et al. The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder. Am J Psychiatry. 2016. PMID: 27690517 PubMed
- Castells X, Blanco‐Silvente L, Cunill R. Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD007813. DOI: 10.1002/14651858.CD007813.pub3. DOI
- Harstad E, Shults J, Barbaresi W, et al. α2-Adrenergic Agonists or Stimulants for Preschool-Age Children With Attention-Deficit/Hyperactivity Disorder. JAMA 2021. doi:10.1001/jama.2021.6118 DOI
- Heilskov Rytter MJ, Andersen LB, Houmann T, et al. Diet in the treatment of ADHD in children-A systematic review of the literature. Nord J Psychiatry 2014;16:1-18. PubMed
- Sonuga-Barke EJS, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 2013. pmid: 23350949 PubMed
- Gillies D, Sinn JKh, Lad SS, et al. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane database of Systematic Reviews 2012; 7: CD007986. pmid: 22786509 PubMed
- Weber W, Stoep AV, McCarty RL et al. Hypericum perforatum (St John's Wort) for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. JAMA 2008; 299: 2633-41. PubMed
- Direktoratet for medisinske produkter: Bruk av markedsførte Melatonin-produkter. Publisert 18.01.2024. Nettsiden besøkt 16.03.25. www.dmp.no
- Van der Heijden KB, Smits MG, Van Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry 2007; 46: 233-41.
- Esposito S, Laino D, D'Alonzo R, Mencarelli A, Di Genova L, Fattorusso A, Argentiero A, Mencaroni E. Pediatric sleep disturbances and treatment with melatonin. J Transl Med. 2019 Mar 12;17(1):77. doi: 10.1186/s12967-019-1835-1. PMID: 30871585 PubMed
- Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder. Lancet. 2020 Feb 8;395(10222):450-462. Epub 2020 Jan 23. PMID: 31982036 PubMed
- Brikell I, Tao H, Li L, et al. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet Psychiatry 2024; 11: 16-26. pmid:38035876 PubMed
- Li L, Zhu N, Zhang L, et al. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. 2024 Mar 12;331(10):850-860. doi: 10.1001/jama.2024.0851. PMID: 38470385 PubMed