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.
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 you experience any of these symptoms, you should talk to your doctor.
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. We do not yet know exactly why some drugs help some people, but not others, nor the exact mechanism that makes stimulants effective. We do know that they work in most people who take them, effectively treating the symptoms of attention deficit disorder.
Medication Used 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 by your psychiatrist or physician, they are safe and effective in the treatment of adult ADHD.
Drug treatment for ADHD began decades ago. Some of the best results have been found with the stimulant drugs listed below. “Approved age” means that the drug has been tested and found safe and effective in children of that age.
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 not convincing evidence that children risk becoming addicted to these drugs, when used for ADHD. In fact, a study at Massachusetts General Hospital and Harvard Medical School found that substance abuse rates were lower among teenagers with ADHD who stayed on their medication than those who stopped.
Many of the stimulant drugs come in short-term and long-term forms, and some are made as “sustained-release” — they are taken in the morning before school and are effective all day. The most suitable preparation for each child will be discussed by the parents and physician.
Even after adjusting the type and dosage of medications, about ten per cent of children will gain no benefit from stimulant drugs. In this case, other types of drug can be tried, such as antidepressants.
Occasionally a child may be prescribed a drug “off label”, meaning that its use in children, or for ADHD has not yet been approved by the FDA. This is common with newer drugs, many of which are given for ADHD. Later studies will produce better evidence on their safety and effectiveness.
Other, newer kinds of drugs, have also been approved for the treatment of attention deficit disorder. 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 of antidepressant 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.
1. ADHD Drug Side- Effects :
The majority of side-effects are minor and do not result in stopping the medication. They may be alleviated by lowering the dosage, but you should always consult the prescribing physician before making any changes to you or your child’s medication.
For most medications prescribed for attention deficit disorder, the most commonly observed side effects are:
- Decreased appetite – often low in the middle of the day and more normal by suppertime. Good nutrition is a priority
- Insomnia – may be relieved by taking the drug earlier in the day, or adding an antidepressant
- Increased anxiety and/or irritability
- Mild stomach aches or headaches
- Tics (more rare)
These medications only control ADHD symptoms on the day they are taken, so it’s important to remember that the disorder is not actually cured. While drugs can enable the child to use their skills more easily, an effort is still needed to improve schoolwork or knowledge in other areas.
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.
2. Helpful Hints About Medication :
- ADHD drugs can help a child focus and improve behavior in many settings
- They may help reduce or avoid emotional problems or addictions
- Four out of five children with ADHD will still need medication as teenagers, and over half as adults
- Children who also have bipolar disorder, and are taking drugs such as lithium or Depakote, may or may not be suitable for ADHD medication as well. If so, it may be given at a lower dose
3. Research References :
One of the large-scale studies that examined medication treatment for ADHD is called the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (or MTA). The MTA included 579 elementary school boys and girls with ADHD. Four treatment four treatment programs were compared: (1) medication management alone; (2) behavioral treatment alone; (3) a combination of both; or (4) routine community care.
Treatment was given for 14 months, during which the children were regularly assessed for ADHD symptoms by specialists and teachers.
The children on medication were seen by the prescribing physician once a month. Those given behavioral treatment met with a behavior therapist up to 35 times and attended a special 8-week summer camp. The routine community care group saw a community-treatment doctor, selected by the parents, once or twice a year.
The best improvements were seen in the group given combined treatments, and the group on medication alone. Of these, combined treatment led to the biggest improvements in anxiety, academic performance, oppositionality, parent-child relations, and social skills. In addition, some children in the combined group could be successfully treated on lower does of medication than those on medication alone.
Another NIMH-funded study investigated drug treatments for pre-schoolers with ADHD. The Treatment of Attention Deficit Hyperactivity Disorder in Preschool-Age Children (PATS) study included 165 children, aged 3 to 5.5 years. It examined the safety and efficacy of a stimulant drug called methylphenidate, which has been widely given to children under the age of 6, despite a lack of evidence on safety and efficacy.
The children appeared to benefit from low doses of methylphenidate, but 11 per cent stopped using the drug because of side-effects. The drug was effective at doses from 7.5 to 30 mg/day, with a mean optimal dose of 14.22 mg/day. (Average adult daily dosage is between 20 mg and 30 mg).
The researchers said that more children taking the drug showed a decrease of ADHD symptoms than did those on placebo. They suggest that preschoolers be started at low doses, and that further studies are needed to test higher doses.
Overall, 30 per cent of parents reported adverse events in their children, including emotional outbursts, difficulty falling asleep, repetitive behaviors/thoughts, irritability, and decreased appetite. But these may have been due as much to lack of medication efficacy as to the action of the drug, said the researchers.
Nevertheless, due to fears over side-effects, preschoolers with ADHD on methylphenidate treatment need to be carefully monitored, they concluded.
Additional Treatments For ADHD
If you use only medication to try and treat attention deficit hyperactivity disorder (ADHD), you’re likely to only get a partial response that does little to help the child or adult with all of the effects of living with ADHD. Psychotherapy and other specific therapeutic interventions are not only important options to consider — they are mandatory in order to treat the long-term issues that go hand-in-hand with attention deficit disorder.
Once some of the behavior problems are under control, the child may be better able to understand the challenges they may have caused to the people around them. Everyone involved can benefit from techniques to manage the past and present consequences of ADHD behavior, and counseling the child and the family group may offer a solution.
Parenting training has been shown to be an effective and an important component of any treatment of ADHD in children. Parents who have a child with an attention deficit disorder should look into getting such training from an ADHD coach or therapist with experience in helping parents with ADHD. These parent training exercises help the parent learn to help their child who has attention deficit disorder, keep their behavior on-task, and correct it in a positive and reinforcing manner when needed. Think of the TV show, “Super Nanny” — except that the therapist helps the parents learn how to best help their child with ADHD.
Psychotherapy For ADHD
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 For 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 attention deficit disorder — 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.
Support Groups For ADHD
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.
Psych Central hosts two support groups online for people with attention deficit disorder: Psych Central ADHD support group and NeuroTalk’s ADHD support group.
Directories
Publications
Annual Reports
