Treatment for attention deficit hyperactivity disorder (ADHD) has two important components — psychotherapy interventions (for both the child and the parents; or the adult with ADHD) and medications. There is a significant amount of research demonstrating that medication alone won’t really help address so many of the core issues a child or adult with ADHD has. So while medication may help with some immediate relief from some of the symptoms, the person with attention deficit disorder still often needs to learn the skills needed to be successful while living with the disorder.
In the past, ADHD treatment has typically focused on medications. The specific class of medication most commonly prescribed for ADHD is stimulants.
These stimulant medications — like Ritalin (methylphenidate) or Adderall (an amphetamine) — are commonly prescribed, well-tolerated, act quickly (usually soon after a person takes them), and in most people, have few side effects. These medications also have a robust research base supporting their effectiveness in treatment of attention deficit disorder.
Children vary a great deal in their response to medication treatments. Finding the combination with the highest efficacy and fewest side-effects is a challenge in every case. A child’s prescribing physician will aim to discover the medication and dose that’s best for your child.
If one medication doesn’t appear to be working after a few weeks of treatment, a doctor will often try another medication. This is normal and most people will switch medications to find the one that works best for them at least once.
The side effects of stimulants may include reduced appetite, headache, a “jittery” feeling, irritability, sleep difficulties, gastrointestinal upset, increased blood pressure, depression or anxiety, and/or psychosis or paranoia. If any of these symptoms are experienced, then the doctor who prescribed them should be contacted. Many parents may be concerned about having stimulant medications prescribed to their child.
This is a typical concern amongst parents, but such medications are not addicting, nor do they produce a “high” in a person with ADHD who takes them. Researchers are still unclear as to why stimulant medications do not “over-stimulate” people who take them, but it is hypothesized that people with ADHD have a problem with certain neurotransmitters in their brain that the medication helps correct. It is unknown exactly why some drugs help some people, but not others, nor the exact mechanism that makes stimulants effective.
However, it is known that they work in most people who take them, effectively treating the symptoms of ADHD. Researchers are concerned how a medication such as Ritalin may interfere with normal brain development. However, stimulant medications such as Ritalin and Adderall have been linked to the sudden death of children and adults that had heart conditions. Because these stimulants increase heart rate and blood pressure it is now recommended that physicians have their patients go through a cardio evaluation prior to starting a stimulant to treat ADHD.
Stimulant medications commonly prescribed for attention deficit disorder include methylphenidate (Ritalin, Concerta, Metadate, Methylin) and certain amphetamines (Dexedrine, Dextrostat, Adderall). Methylphenidate is a short acting drug, and in older forms, had to be taken multiple times a day. Longer-acting versions of the drug are now available for once-daily use. Although taking stimulants for treatment may seem risky, there is significant research that demonstrates that when taken as directed, they are safe and effective in the treatment of adult ADHD. Stimulant drugs are often beneficial in curbing hyperactivity and impulsivity, and helping the individual to focus, work, and learn.
Sometimes the drugs will also help with coordination problems which may hinder sports and handwriting. Under medical supervision, these stimulant drugs are quite safe and do not make the child feel “high”, although they may feel slightly different. To date, there is no convincing evidence that children risk becoming addicted to these drugs, when used for ADHD. In fact, “a review of all long-term studies on stimulant medication and substance abuse, conducted by researchers at Massachusetts General Hospital and Harvard Medical School, found that teenagers with ADHD who remained on their medication during the teen years had a lower likelihood of substance abuse than did ADHD adolescents who were not taking medications.” (2013)
Other, newer kinds of drugs, have also been approved for the treatment of ADHD. These non-stimulant medications include Strattera (atomoxetine, a selective norepinephrine reuptake inhibitor) and Vyvanse (lisdexamfetamine dimesylate). These drugs typically offer similar benefits to stimulants, but act in a different way on the brain. Some people may find they better tolerate these drugs.
Another useful category of drugs for adults with ADHD are the antidepressants, either alongside or instead of stimulants. Antidepressants which target the brain chemicals dopamine and norepinephrine are the most effective. These include the older form ofantidepressant known as the tricyclics, as well as new antidepressants, such as Venlafaxine (Effexor). The antidepressant Bupropion (Wellbutrin) has been found useful in trials of adult ADHD, and may also help reduce nicotine cravings.
Some medications for ADHD can bring on symptoms of hostility, anxiety, depression and/or paranoia. People with a family history of suicide are at greater risk and should be closely monitored while taking stimulants to treat their ADHD. The majority of side-effects are minor and do not result in stopping the medication. They may be alleviated by lowering the dosage, but the prescribing physician should be contacted before making any changes to any. Another growing concern of taking stimulants, is the weight loss properties of the drug or the alertness it gives to someone who takes the medication, but doesn’t suffer from ADHD.
A study that was at Columbia University 2003, found that “ As many as 20 percent of college students have used Ritalin or Adderall to study, write papers and take exams, according to recent surveys focused on individual campuses.” (New York Times News) 2005. Parents should be aware of the amount of medication that their children have and talk to their children about the dangers of sharing or selling their medication.
This would make the medication an illicit drug and criminal charges will be laid if anything happens to someone who took the drug that it was not prescribed to. Some side effects in dealing with ADHD medication do go away after the first few weeks. People on ADHD medication my experience loss of appetite, insomnia, upset stomach, headaches, dizziness, and mood changes. If any of these side effects are bothersome, the patient should speak to their doctor about adjusting the dosage or trying an alternative drug. As well as medication, behavioral therapy, emotional counseling, and practical support will also help a person with ADHD cope with the disadvantages of the disorder.
We have decades’ worth of research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people turn to psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Both approaches are clinically accepted. In psychotherapy (commonly, cognitive-behavioral therapy for ADHD), the child can be helped to talk about upsetting thoughts and feelings, explore self-defeating patterns of behavior, learn alternative ways to handle emotions, feel better about him or herself despite the disorder, identify and build on their strengths, answer unhealthy or irrational thoughts, cope with daily problems, and control their attention and aggression.
Such therapy can also help the family to better handle the disruptive behaviors, promote change, develop techniques for coping with, and improving their child’s behavior. Behavioral therapy is a specific type of psychotherapy that focuses more on ways to deal with immediate issues. It tackles thinking and coping patterns directly, without trying to understand their origins. The aim is behavior change, such as organizing tasks or schoolwork in a better way, or dealing with emotionally charged events when they occur.
In behavior therapy, the child may be asked to monitor their actions and give themselves rewards for positive behavior such as stopping to think through the situation before reacting. Psychotherapy will also help a person with attention deficit disorder to boost their self-esteem through improved self-awareness and compassion. Psychotherapy also offers support during the changes brought about through medication and conscious efforts to alter behavior, and can help limit any destructive consequences of ADHD.
Social skills training teaches the behaviors necessary to develop and maintain good social relationships, such as waiting for a turn, sharing toys, asking for help, or certain ways of responding to teasing. These skills are usually not taught in the classroom or by parents — they are typically learned naturally by most children by watching and repeating other behaviors they see. But some children — especially those with ADHD — have a harder time learning these skills or using them appropriately. Social skills training, helps the child to learn and use these skills in a safe practice environment with the therapist (or parent).
Skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. Social skills training is done in a therapy office, or parents can learn them and teach them in the home. The therapist teaches the behaviors that are appropriate in different situations and then those new behaviors are practiced with the therapist. Clues that can be taken from people’s facial expressions and tone of voice may be discussed.
Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone.
As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists. For people who are either uncomfortable openly talking about their issues with ADHD or are simply not able to attend support groups, there are online support groups such as, Psych Central that hosts two support groups online for people with ADHD: Psych Central ADHD support group and NeuroTalk’s ADHD support group.