What are the main forms of ADHD treatment?
According to the National Institute of Mental Health, there is no cure for attention deficit hyperactivity disorder. However, the NIMH claims that treatments can help reduce the symptoms of ADHD, which may include wandering off the task, extreme agitation, acting without considering the long-term consequences – or a mixture of these behaviors. “Treatments include medications, psychotherapy, education or training, or a combination of treatments,” says the NIMH.
When it comes to ADHD medications for children, Dr. Rebecca A. Baum, head of behavioral pediatrics at the National Children’s Hospital and associate clinical professor of pediatrics at Ohio State University, explains that there are two groups of medications: stimulants and not stimulants – they are approved by the FDA.
Stimulants, she explains, “stimulate the part of the brain that deals with attention and focus” and are considered to have the best evidence of effectiveness. “Today, there are several different stimulant medications to choose from, so people are able to find one that works well with minimal side effects.” Examples of commonly prescribed stimulants include Ritalin, Evekeo, Adderall, and Concerta.
As for non-stimulant drugs, she says that they are typically less effective and therefore not so frequently used. For example, one type, atomoxetine, has been found to be only about two thirds as effective as stimulant medicines.
As with all medications – ADHD or otherwise – side effects can occur. Baum explains that with stimulants, a child may experience a decrease in appetite, social withdrawal or being more agitated or emotional. “We work with parents,” says Baum, “to understand any newly observed behavior or other changes in an effort to achieve optimal dosing.”
Non-stimulant side effects, according to Baum, may be more alarming for parents. She says there are two groups of non-stimulants: atomoxetine, which is known by the brand Strattera, and alpha agonists, which are known by the brands Kapvay and Intuniv. Atomoxetine includes a warning that suicidal thoughts can occur, while alpha agonists, she explains, can lower heart rate and blood pressure, leading to a risk of sedation in which a person may become slow.
The challenge, according to Baum, is that different drugs can work well for one child, but not for the other. “It is a matter of trial and error,” she says, adding that it is also necessary to determine if a child actually has ADHD or if he or she has an underlying disorder.
Recommendations for children
For preschoolers, Baum says underlying factors such as sleep deprivation and learning difficulties are common and can create symptoms similar to ADHD. “Medication is not usually recommended at this age,” he says. “On the other hand, behavioral therapy is often the first line of treatment.”
Drugs or behavioral therapy, or both, are often treatments for children in elementary school, says Baum. Behavioral therapy at this stage, he explains, typically involves intervention with parents to teach them ways to encourage and shape their child’s behaviors.
As for adolescents, the non-profit organization and children and adults with Attention Deficit Hyperactivity Disorder, or CHADD, says that “successful treatment usually involves a combination of education, behavioral therapy and medication.”
Adults with ADHD
According to Dr. L. Eugene Arnold, emeritus professor of psychiatry and behavioral health at the Nisonger Center at Wexner Medical Center at Ohio State University, adults often receive the same medications as children. “Most of what is used is stimulants,” he says.
However, he says none of them are 100 percent effective. Echoing Baum’s comment, he says that each individual has to find what works best.
He also stressed that antipsychotics should be used as a last resort because they have been shown to have neurological and metabolic risks. The NIMH says that according to the FDA, “antipsychotic medications are often used in combination with other medications to treat delirium, dementia and mental health conditions,” including ADHD. The FDA notes that weight gain may be a risk of taking such medications, as well as the occurrence of tremors, blurred vision and seizures.
Arnold says that cognitive behavioral therapy – a method to help change behaviors or thought patterns that contribute to a person’s life struggles – is beneficial for adults. CHADD also points out its importance. “While medication helps control the central symptoms of distractibility, short attention span and impulsivity,” says CHADD, “CBT is more effective in increasing the habits and skills necessary for executive self-management and can also Serve to improve emotional and interpersonal self-regulation. ”
Exercise, too, is something that Arnold feels may be useful for people with ADHD, as it is helpful for the brain. Proper nutrition should also be part of the picture – both for children and for adults – notes, referring to evidence suggesting that omega-3 fatty acids may be helpful for someone with ADHD. Baum agrees that diet, exercise and meditation can be beneficial. However, he notes that there is not much evidence that these areas specifically help with ADHD, but since it is well established that healthy eating and regular exercise are ideal for the general population, it can not harm in any way.
Sleep should also be treated, says Arnold. “Sleep deprivation can mimic the symptoms of ADHD,” he says. School-age children should receive 10 hours, adolescents nine hours, adults eight or more. Actually, he explains, people sleep on average an hour less than they should be. “If we solve the problem of sleep deprivation, I think we would see a decrease in the prevalence and severity of ADHD.”
Find the balance, accentuate the positives
Arnold says treating ADHD often comes down to people who find a balance that works best for each person. “People with ADHD have to develop habits,” he says. “For a person without ADHD, this is second nature, but a person with the disorder has to go about systematically developing one good habit at a time to overcome ADHD.”
Baum emphasizes the importance of parents engaging in the educational environment of their children. “Participate with the teacher, get feedback from them, create parent-teacher goals, and establish a consistent approach to behavior expectations at home and at school,” he says. For example, if the school has a “beware of self-restraint” rule, Baum explains that the same notion should be enforced and reinforced at home. In addition, it encourages parents to learn more about special education services that can help their child, saying that wrightslaw.com can be a useful resource.
Overall, it says that it is essential to focus on the positive aspects of ADHD. “It is important to take into account the strengths and positive qualities for all children, but especially among those with ADHD,” he says. “There is often so much negative information, so it is good for a child to hear when they are doing well and to celebrate and highlight their successes.”