Child and Adolescent Psychiatry

Disorders of Attention and Activity 63

imipramine. Medication should always be part of an integrated treatment
package. A good response to medication is the beginning rather than the
end of treatment – increasing the chance of successful work with the
family and the school to get the child back on to as normal a developmental
trajectory as possible.

Diet
Dietary treatment is popular with parents, and often needs to be explored
before the family are willing to try anything else. Removal of food colours
from the diet results in a small improvement in some children with
ADHD, and this is not just suggestibility since it has been confirmed with
‘blind’ challenges. In addition, several trials have demonstrated that some
children improve when specific foods are excluded from their diets –
though it is still uncertain whether diet-responsive children are rare or
common. It is not possible to predict on the basis of blood or skin tests
which children will respond, or which foods are responsible. Additives are
rarely the only culprits; one or more natural foods, such as milk, wheat
products or oranges, are usually involved as well. As described in Chapter
38, a proper trial of dietary treatment is very hard work for all concerned.

Prognosis

Over-activity typically wanes in adolescence, though many affected indi-
viduals have continuing problems with inattentiveness, impulsiveness and
an inner sense of restlessness even in adult life. Educational attainments
are often poor, which may account for lower occupational status in adult
life. Individuals with both ADHD and a behavioural disorder are at high
risk of antisocial personality disorder and substance abuse in adult life;
individuals with ‘pure’ ADHD are at less risk of these antisocial outcomes,
though they are still vulnerable.

Subject review

Taylor E, Sonuga-Barke E. (2008) Disorders of attention and activity.
In: Rutter Met al.(eds)Rutter’s Child and Adolescent Psychiatry,5thedn.
Wiley-Blackwell, Chichester, pp. 521–542.

Further reading

Faraone SVet al. (2008) Effect of stimulants on height and weight: A
review of the literature.Journal of the American Academy of Child and
Adolescent Psychiatry 47 , 994–1008.
Graham Jet al. (2011) European guidelines on managing adverse effects of
medication for ADHD.European Child and Adolescent Psychiatry 20 , 17–37.