Treatment

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An effective treatment plan will help you cope with ADHD, whether you or your child is the one with the diagnosis. For adults, the treatment plan may include medication along with practical and emotional support. For children and adolescents, it may include providing an appropriate classroom setting, as well as medication and helping parents understand and manage the child's behavior.

Research shows that a combination of medication and ADHD-focused counseling and behavior management is generally the most successful ADHD treatment.

For decades, medications have been used to treat the symptoms of ADHD. Three medications in the class of medications known as psychostimulants, or stimulants, seem to be the most effective in both children and adults. These are:

• Methylphenidate (Ritalin, Metadate ER, and long-acting forms of methylphenidate, Concerta, Metadate CD, Ritalin LA) A new methylphenidate transdermal patch—called Daytrana—was approved in 2006 for treating ADHD in children aged six to 12.

• Dextroamphetamine/amphetamine (Dexedrine, Dextrostat, Adderall and the long-acting form of amphetamine salts, Adderall XR.) Adderall XR was approved in August 2004 by the U.S. Food and Drug Administration (FDA) to treat adults with ADHD. Note: Adderall carries a "black box warning" about the potential for substance abuse and also warns individuals with a heart condition not to use the drug because of the risk of serious cardiovascular events and sudden death.

Potential side effects, such as weight loss, slow growth, and tics, should be carefully weighed against the benefits before prescribing the medications. However, most side effects can often be handled by reducing the dosage.

Additionally, a 10-year study by the National Institute of Mental Health found that while the brains of children and adolescents with ADHD are three to four percent smaller than those of children who don't have the disorder, medication is not the cause. In fact, researchers suggest, medication may actually help the brain mature.

There has been some concern that long-term use of stimulants might lead to substance abuse. Because adult ADHD is viewed as a chronic, life-long condition continuing from early childhood, it is often recommended that patients continue drug therapy with stimulants through adulthood. However, this typically doesn't occur. Additionally, we know little about the long-term effects of stimulant medication, because few longitudinal studies have followed children with ADHD receiving stimulant therapy into adulthood. Therefore, it is not known if long-term use of stimulants is associated with a greater incidence of adult substance abuse (although studies suggest it isn't).

There has also been concern that stimulant medication affects children's growth, with some studies showing a correlation. But a study published in the Journal of American Academy Child Adolescent Psychiatry on children who used the long-acting form of methylphenidate for 21 months showed no significant differences in growth patterns between children taking the medication and those not taking it.

There has also been a concern about tics as a side effect of stimulant medication. However, a two-year follow-up of children and adolescents treated with Concerta found that tics improved or remained the same in the majority of children. This finding suggests that tics may not be a reason to withhold stimulant medication for ADHD.

Atomoxetine (Strattera). The first non-stimulant medication approved to treat ADHD, Strattera is classified as a "selective norepinephrine reuptake inhibitor." It works by blocking protein in the brain to increase norepinephrine.

Strattera carries a "black box warning" about the potential for liver damage as well as the increased risk of suicide. Call your health care professional right away if you or your child has thoughts of suicide or a sudden change in mood or behavior, especially at the beginning of treatment or after a change in dose.

Strattera is not classified as a controlled substance like the other ADHD medications (i.e., the stimulants), although it is a prescription drug. Side effects include: decreased appetite, upset stomach, nausea or vomiting, and fatigue. In addition, some of the most common side effects in adults are problems sleeping, dry mouth, dizziness, problems urinating and sexual side effects.

Different health care professionals use the medications in slightly different ways. Ritalin and Dexedrine come in short-term tablets that last about three to five hours, as well as longer-acting preparations that last for eight to 12 hours.

For many people, these medicines dramatically reduce the hyperactivity and the inability to focus, work and learn. They may also improve physical coordination, such as handwriting.

Other types of medications are sometimes used to treat the condition if stimulants don't work or if the ADHD occurs with another disorder. These medications are not approved for the treatment of ADHD, yet many have been shown effective in at least some studies.

For example, clonidine (Catapres), a medication normally used to treat hypertension, may be helpful in people with both ADHD and Tourette syndrome. Clonidine can be administered either by pill or skin patch and has different side effects than stimulants, including rash, constipation and nervousness. Other medications that may be prescribed include the antidepressants desipramine (Norpramin), imipramine (Tofranil) and bupropion (Wellbutrin). Note: Norpramin is not approved for use in treating children, but may be prescribed "off label."

Antidepressant labels now carry a "black box warning" concerning the increased risk of suicidal thoughts and behavior that accompanies these drugs. Short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders showed an increased risk of suicide in those taking antidepressants. Therefore, anyone considering the use of an antidepressant in a child or adolescent must balance this risk with the need for the drug.

Also, health care professionals should observe their patients closely for any increased risk of suicide or unusual changes in behavior. Families and caregivers should also closely watch patients.

Stimulant medications, when used with medical supervision, are usually considered safe, although they can be addictive if misused. Stimulants seldom make children with ADHD "high" or jittery. Nor do they have a sedative effect. Rather, the stimulants help children control their hyperactivity, inattention and other ADHD-related behaviors.

Medication alone isn't enough to treat ADHD, however, and it won't cure the disorder, it will just control the symptoms while you're taking the medication. For instance, stimulants have only immediate benefits, so once a dose wears off the symptoms return.

Also, although the medications may help you pay better attention to and complete your work, they can't increase your knowledge or improve your (or your child's) academic skills. The medications alone can't make you feel better about yourself or cope with problems. These issues require other kinds of treatment and support.

For lasting improvement, clinicians recommend that medications be used along with treatments that aid in these other areas. Many experts believe that the most significant, long-lasting gains appear when medication is combined with behavioral therapy, counseling and practical support.

Psychosocial Treatment

Although ADHD primarily affects a person's behavior, the disorder has broad emotional repercussions. Scolding is the only attention some people with ADHD ever get while growing up. They may have few positive experiences to build their sense of worth and competence. Facing the daily frustrations that can come with having ADHD can make people fear that they are strange, abnormal or stupid.

Often the cycle of frustration, blame and anger has gone on so long it takes some time to undo. In such cases, mental health professionals can help adults with ADHD develop new skills, attitudes and ways of relating to other people.

In group counseling, for example, people learn that they are not alone and that others want to help. Sometimes just the person with ADHD needs counseling support. But because the problem affects the entire family therapy can also be helpful.

Several types of therapy are available, with different therapists preferring different approaches. Knowing something about the various types of interventions makes it easier to choose a therapist.

• Psychotherapy works to help people with ADHD like and accept themselves despite their disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change. However, people dealing with ADHD usually want to gain control of their symptomatic behaviors more directly. The following intervention can provide that help.

• Behavior therapy, used with children and adolescents, involves providing parents with education about ADHD, teaching them to use regular and consistent rewards and punishments with their children, and coordinating efforts with teachers at school

• Cognitive-behavioral therapy helps you work on immediate issues. Rather than helping you understand your feelings and actions, it directly supports you directly in changing your behavior. The support might be practical assistance, like learning to think through tasks and organize work. Or the support might be encouraging new behaviors through praise or rewards.

• Social skills training also helps children and adults learn new behaviors, specifically social behaviors. In social skills training, the therapist discusses and models appropriate behaviors and helps the patient practice the new behavior.

• Support groups connect people who have common concerns. Many adults with ADHD and parents of children with ADHD find it useful to join a local or national support group. Many groups deal with issues of children's disorders, and even ADHD specifically.

Ineffective or unproven alternative treatments

The following treatments have NOT been scientifically shown to be effective in treating people with ADHD:

• restricted diets

• allergy treatments

• medicines to correct problems in the inner ear

• megavitamins

• chiropractic adjustment and bone re-alignment

• treatment for yeast infection

• eye training

• special colored glasses

Be cautious about pursuing treatments that are not supported by scientific research and/or the U.S. Food and Drug Administration. Until sound, scientific testing shows a treatment to be effective, families risk spending time, money and hope on fads and false promises.

Managing Your Life as an Adult with ADHD

Here are some practical steps you can take to manage your life with ADHD, courtesy of ADHD expert Kathleen Nadeau, PhD.

1. Give yourself a break. Often the biggest struggle is an internal one. High expectations have been deeply ingrained in many women. Breaking out of a mold that doesn't fit can take time and effort. Psychotherapy can help.

2. Educate your partner about ADHD and how it affects you. Your partner may feel anger and resentment about a less-than-organized lifestyle. Strategize how to make your life at home and work more "ADHD-accommodating" and "ADHD-friendly."

3. Try to create an "ADHD-friendly" environment in your home and work. If you can approach your ADHD with acceptance and good humor, explosions will decrease and you'll save more energy for the positive side of things.

4. Simplify your life. Look for ways to reduce commitments so you're not always pressed for time and hurried.

5. Choose supportive friends. Many women describe friends or neighbors whose houses are immaculate, whose children are always clean, neat and well-behaved who make them feel terrible by comparison. Don't put yourself in situations that lead you to impossible expectations and negative comparisons.

6. Build a support group for yourself. For example, ask a friend or relative who understands your condition to keep you company while completing some regularly scheduled task that is always difficult for you.

7. Build in daily breaks. This is essential when you have ADHD, especially if you're raising children. Make them routine so that you don't have to keep planning and juggling. For example, arrange for a regular babysitter several times a week to stay with your children so you may have a break.

8. Eliminate and delegate. Look at things that you require of yourself at home or on the job. Can some of these things be eliminated? Can you afford to hire someone to do some of them?

9. Get help for premenstrual or menopausal symptoms. They may be more severe in women with ADHD than in other women. Managing the destabilizing effect of your hormonal fluctuations is a critical part of managing your ADHD.

10. Make lists and encourage other family members to list and record activities, responsibilities and events. Post as many lists as necessary around the house to help remind you and others about priorities.

11. Create filing systems or organizational systems that work for you. Don't let yourself be overwhelmed at home or at the office by mountains of paperwork.