Treatment Options for ADHD/ADD
Whether you have been formally diagnosed with attention-deficit/hyperactivity disorder (ADHD), or simply feel as if you have significant difficulties establishing and maintaining your focus in your daily life, the first question for many is often, “what are the options to improve an individual’s focus?”
Many people assume that the best and only way to treat these difficulties is through the use of medications. While medications can be impactful for some, it is far from the only option available. In these article, we will attempt to discuss the different types of treatment for ADHD/ADD, as well as the appropriateness and strengths and weaknesses of each.
Treatment Options for ADHD/ADD in Children
For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together. Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school supports. Additional information regarding the IEP process and obtaining classroom accommodations can be found here.
Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, as well as making changes as needed along the way.
Behavior Therapy, Including Training for Parents
ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children. Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.
The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include:
These approaches can also be used together. For children who attend early childhood programs, it is usually most effective if parents and educators work together to help the child.
For young children with ADHD, behavior therapy is an important first step before trying medication because:
Parent training in behavior management gives parents the skills and strategies to help their child.
Parent training in behavior management has been shown to work as well as medication for ADHD in young children.
Young children have more side effects from ADHD medications than older children.
The long-term effects of ADHD medications on young children have not been well-studied.
For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. In addition to the interventions detailed above, additional emphasis on Peer Interventions and Organizational Skills can also be integral to successfully managing symptoms.
These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.
Medications
Medication can help both children and adults manage their ADHD symptoms in their everyday life and can help them control the behaviors that cause difficulties with family, friends, and at school. However, it is important to understand the pros and cons to utilizing different classes of medications. Medications can affect people differently and can have side effects such as decreased appetite or sleep problems. One person may respond well to one medication, but not to another.
Several different types of medications are FDA-approved to treat ADHD in children as young as 6 years of age:
Stimulants are the best-known and most widely used ADHD medications. Between 70-80% of children with ADHD have fewer ADHD symptoms when taking these fast-acting medications. They’re used to treat moderate and severe ADHD. They may be helpful for children, teens, and adults who have a hard time at school, work, or home. Some stimulants are approved for use in children over age 3. Others are approved for children over age 6.
Short-Acting Stimulants and Side Effects
Side effects of short-acting stimulants include loss of appetite, weight loss, sleep problems, agitation, and tics. They also have a very short half-life in order to allow an individual to sleep, so you have to take them often in order to have continued effect. The FDA has issued a warning about the risk of drug abuse with amphetamine stimulants. FDA safety advisers are also concerned that all amphetamine and methylphenidate stimulants used for ADHD may make heart and psychiatric problems more likely.
Intermediate and Long-Acting Stimulants and Side Effects
Much like shorter-acting medications, side effects of these medications include loss of appetite, weight loss, sleep problems, agitation, and tics. However, long-acting medicines may have an even greater negative impact on appetite and sleep. Similar to short-acting stimulants, the FDA warns about the risk of drug abuse with amphetamine stimulants and have expressed concerns about their potential to have a negative impact on heart and mental health, as well.
Nonstimulants were approved for the treatment of ADHD in 2003. They do not work as quickly as stimulants, but their effect can last up to 24 hours.
Non-Stimulant ADHD Medications and Side Effects
Non-stimulant medications usually take a while to start working. It could be several weeks before you feel the full effects. Also, they may not work as well as stimulants. Some non-stimulant medications may raise the risk of suicidal thoughts and death by suicide in teens. The FDA warns that anyone taking atomoxetine (Strattera) should be monitored for suicidal thoughts, especially during the first few weeks. Common side effects of these drugs include fatigue, upset stomach, dry mouth, and nausea. Your blood pressure often rises when you stop taking them.
Antidepressants can also be used with individuals suffering from ADHD/ADD. Not only do people with ADHD often struggle with secondary conditions such as depression and anxiety, but these conditions can often act to make the initial concentration deficits of ADHD/ADD even worse. Antidepressants can help to alleviate the exacerbating mood symptoms, but some classes of antidepressants have even been observed to have a positive impact on focus on their own.
Antidepressant ADHD Medications and Side Effects
These medications can be used off-label to treat ADHD symptoms. That means doctors can prescribe them even though they haven’t been approved by the FDA for use with ADHD, Side effects often include trouble sleeping, nausea, constipation, dry mouth, sweating, and changes in sex drive. The FDA has also warned about a connection between antidepressants and a higher risk of suicide in adults ages 18-24, especially in the first 1 or 2 months.
Healthcare providers who prescribe medication may need to try different medications and doses. The AAP recommends that healthcare providers observe and adjust the dose of medication to find the right balance between benefits and side effects.
Neurotherapy
Neurofeedback treatment is an ADHD/ADD therapy that uses real-time EEG brainwave data to enable patients to train their brain to be in better control of impulses and improve focus and executive functioning. The benefits of neurotherapy have been found to be two-fold, in that brainwave alterations are measurable and found to last well beyond the end of therapy. And secondly, these brainwave improvements can lead to behavioral improvements, notably in maintaining focus, reduced impulsivity, and reduced distractability. The concept of neurotherapy is based on the neuroplasticity of the brain. The brain is malleable and with repeated and intense practice, brainwave activity transforms and increases the ratio of high-frequency brainwave activity, thus leading to greater self-control and attention. The brains of ADHD/ADD patients tend to generate excess low-frequency delta or theta brainwaves, combined with a possible shortage of high-frequency beta brainwaves. Neurotherapy treatment works to increase the brain’s capacity to generate beta waves, associated with problem solving and processing information, and thus reduce ADHD/ADD symptoms.
Neurotherapy provides a treatment option that is typically long-lasting and without the same risk of side effects associated with medication. While neurotherapy will typically need to be combined with behavioral strategies in order to achieve maximum effectiveness, it provides a safe and effective alternative to medication-based interventions.
Tips for Parents
The following are suggestions that may help with your child’s behavior:
Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime, and try to follow this routine as closely as possible on a daily basis - including on weekends.
Get organized. Encourage your child to put schoolbags, clothing, and toys in the same place every day so that they will be less likely to lose them.
Manage distractions. Turn off the TV, limit noise, and provide a clean workspace when your child is doing homework. Some children with ADHD learn well if they are moving or listening to background music. Watch your child and see what works.
Limit choices. To help your child not feel overwhelmed or overstimulated, offer choices with only a few options. For example, have them choose between this outfit or that one, this meal or that one, or this toy or that one.
Be clear and specific when you talk with your child. Let your child know you are listening by describing what you heard them say. Use clear, brief directions when they need to do something.
Help your child plan. Break down complicated tasks into simpler, shorter steps. For long tasks, starting early and taking breaks may help limit stress.
Use goals and praise or other rewards. Use a chart to list goals and track positive behaviors, then let your child know they have done well by telling them or by rewarding their efforts in other ways. Be sure the goals are realistic—small steps are important!
Create positive opportunities. Children with ADHD may find certain situations stressful. Finding out and encouraging what your child does well—whether it’s school, sports, art, music, or play—can help create positive experiences.
Provide a healthy lifestyle. Nutritious food, lots of physical activity, and sufficient sleep are important; they can help keep ADHD symptoms from getting worse.
ADHD in Adults
ADHD lasts into adulthood for at least one-third of children with ADHD (Barbaresi et al., 2013). Treatments for adults can include medication, psychotherapy, education or training, or a combination of treatments. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD and the National Institutes of Mental Health.
References:
Centers for Disease Control and Prevention (CDC). (2021, September 23). Treatment of ADHD. https://www.cdc.gov/ncbddd/adhd/treatment.html.
Barbaresi, WJ, Colligan, RC, Weaver, AL, Voigt, RG, Killian, JM, & Katusic, SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: A prospective study. Pediatrics; 2013; 131(4), 637-644.