About ADHD: Treatment, Services and Support
When people living with ADHD are appropriately treated (i.e. when their treatment plan is uniquely tailored to their individual needs and the intervention of treatment is early on), they can lead very productive and satisfying lives. Without suitable treatment, however, ADHD can lead to several consequences including school drop-out, depression, conduct disorder, failed relationships, underachievement in the workplace and substance abuse. Getting a comprehensive evaluation that looks at the whole person—the strengths, interests, relationships, aptitudes, school or work environment and family—is key to the development of a successful individualized treatment plan.
A key aspect of treating ADHD is taking a “multimodal” approach. This means utilizing multiple methods for treatment including medical, educational, behavioral and psychological. A research study was done by the National Institute of Mental Health (NIMH) called the Multimodal Treatment Study of Children with ADHD (MTA). Five hundred and seventy nine children living with the combined type of ADHD were given one of four possible treatments over a 14-month period. The four treatments were medication management, behavioral treatment, a combination of the two or usual community care. The combination treatment of medication and behavior therapy showed the most improved symptoms.
For children and youth living with ADHD, the multimodal approach should include looking at their school placement and, when indicated, understanding their learning style. Learning differences are common in children and youth with ADHD. The two best studied interventions for ADHD are medication and behavioral treatment.
Medication
Finding the right medication and assessing how it can be helpful on key target symptoms is an important aspect to the person and health care professional working together to develop a care plan.
Medication is used to improve the symptoms of ADHD so that the individual can function more effectively. The most widely used medications for ADHD are psychostimulants. These medications help important networks of nerve cells in the brain to communicate more effectively with each other. When the medicine is active, it alleviates ADHD symptoms. Seventy to 80 percent of children living with ADHD have a positive response to psychostimulants. Results often include improved attention span, reduced impulsivity and improved on-task behavior. Other possible improvements are in frustration tolerance, compliance, better handwriting and enhanced relationships with parents, teachers and peers. When beginning treatment, a medication trial is often used to find the right dosage. Long acting medications are often preferred because they last longer throughout the day, which helps avoid ups and downs.
However, some people respond just as well or better to nonstimulant medication. Nonstimulant medications are usually taken when stimulants have caused unwanted side effects or have been ineffective for some reason. A nonstimulant medication alleviates inattention and hyperactivity/impulsivity symptoms of ADHD by affecting specific aspects of the norepinephrine system. The norepinephrine system affects parts of the brain where attention and responding actions are controlled. This medication takes longer to work than the stimulants. There are medicines that health care providers may recommend that are not FDA approved for this indication. If such is the case, people should ask a lot of questions and understand why there is a recommendation for “off label” medication treatment. Some antidepressants may fall into this category.
The most common side effects related to these medications are reduction in appetite, difficulty sleeping, headache and stomach ache. Some children experience “stimulant rebound” when the medication is wearing off. A “stimulant rebound” is a short period of negative mood, fatigue or increased activity but can be managed by changing the dose and scheduling of the medicine. For more information on side effects, ask a physician or other medical professional.
The FDA has labeled stimulants with a “black box” warning, which should be recognized as the most serious “stop sign” the FDA has for prescribers and patients to consider before starting any medication. The FDA warning is as follows.
Drug Dependence
[TRADEMARK]* should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abuse can lead to marked tolerance and physiological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during withdrawal from abusive use since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.
*Name of drug goes here.
FDA-approved medicines have been shown to meet their standards for clinical usefulness and safety. Selecting the right medication is a process between the prescriber, the individual and the family and is benefited by the use of rating scales to make clear what is and is not working to help inform the medication trial. Often the individual will report his or her experience—good or bad—on the compound.
Some important aspects of treating ADHD with medication should be considered. For example, figuring out the proper dosage and scheduling of medication for each individual may take a few weeks. During transition stages, from childhood to adolescence to adulthood, doses may need to be changed or monitored to continue optimal treatment for the individual. Another issue that should be carefully discussed with your medical professional is whether medication should be taken outside of school/during the summer months.
There are some cases in which people take stimulant medications without prescriptions. One area where this can occur is on college campuses, where some students sell their medications to other college students who do not have a disorder. In these cases, the medication is being viewed and handled as an “academic steroid.” This practice, called diversion, is not only illegal, it’s also very dangerous. Anyone who takes prescription medication should be receiving that medication under the care of a medical professional.
The FDA regularly approves medicines for treatment. Visit FDA.gov for a list of the most recent approved medicines.
FDA-approved Stimulants
- Methylphenidate (generic name), Methylin, Ritalin, Metadate ER, Methylin ER, Metadate CD, Ritalin LA, Concerta (brand name).
- Methylphenidate transdermal patch (generic), Daytrana (brand).
- Methylphenidate SR (generic), Ritalin SR (brand).
- Dexmethylphenidate SR (generic), Focalin, Focalin XR (brand).
- Dextroamphetamine (generic), Dexedrine, DextroStat, Dexedrine, Spansule (brand).
- Lisdexamfetemine Dimesylate (generic), Vyvanse (brand).
- Mixed amphetamine salts (generic), Adderall, Adderall XR (brand).
FDA-approved Nonstimulants
- Guanfacine (generic), Intuniv (brand name).
- Atomoxetine (generic), Strattera (brand).
FDA-approved Antidepressants
- Bupropion (generic), Wellbutrin, Wellbutrin XL, Wellbutrin SR (brand).
For detailed information on these medicines and side effects, download the medication chart from the National Resource Center on ADHD .
Behavioral Treatment
Behavior therapy, also known as psychosocial treatment, helps change the behaviors of children or adolescents living with ADHD. It helps with issues such as behavior problems at school and problems getting along with family and peers. With behavior therapy, parents, teachers and children living with ADHD learn new skills for interacting with others. This starts by setting small, achievable goals for the child and being very consistent and understanding throughout the treatment. Parents are trained to set house rules and a specific routine, praise wanted behaviors and ignore mild unwanted behaviors. Parents are also trained to use “when/then” directions (“when there is unwanted behavior, then adults take away privileges”), plan ahead, encourage their child to practice good behavior in public and use “time outs.” Parents can also use daily charts and point systems for rewards and consequences as well as track homework and school successes. Working with a child’s teachers to instill the same behavior is a good way to enforce changes. Read more about parenting and ADHD.
Complementary and Alternative Treatments for ADHD
Complementary and alternative treatments for ADHD are treatments other than medication and behavioral therapy that some families have found to help treat symptoms. However, they are not scientifically proven to be effective, so individuals are encouraged to consult with medical doctors before using any interventions.
- Dietary Interventions
- Elimination diets are based on the theory that many children are sensitive to dietary salicylates and artificially added colors, flavors and preservatives, and that eliminating these substances from the diet could improve learning and behavioral problems
- Nutritional supplements. ADHD causes some chemicals in the brain to not function as well, so some people believe that persons living with ADHD have a deficiency of fatty acids which can be solved with supplements (such as omega-3).
- Interactive metronome training is where a computerized metronome produces a rhythmic beat that individuals attempt to match with hand or foot tapping. It is suggested that improvement in matching the beat reflects gains in motor planning and timing skills.
- Chiropractic medicine is based on a chiropractic theory that muscle tone imbalance causes an imbalance in brain activity. According to this theory, by adjusting the ADHD patient’s spine, balance is restored in the brain
- Neurofeedback (EEG biofeedback) is based on the findings that individuals living with ADHD show low levels of arousal in frontal brain areas. Neurofeedback treatment involves teaching the patient how to increase their arousal levels. The patient’s brain activity is monitored through electrodes hooked up to their head. When the brain waves reach a desired frequency, a signal informs the patient. Through training, the patient can ultimately learn how to increase arousal on his or her own.
Visit NAMI Hearts & Minds for information on wellness strategies, including mindfulness, and the National Institute of Health’s National Center for Complementary and Alternative Medicine for additional resources and information.
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