ADHD Treatment

ADHD symptoms can be managed effectively with the right treatment. There are many ADHD treatment options, and the best approach depends on the individual’s symptoms, personal life, and preferences. Treatment tends to be most effective when it starts early and is tailored to the specific needs of the individual with ADHD. 

Healthcare Providers 

Various healthcare providers can offer ADHD services, including pediatricians, psychiatrists, neurologists, psychologists, and advanced practice nurses. Other professionals such as social workers or art therapists may also be involved in different aspects of ADHD treatment. 

ADHD Treatment Options

The recommended treatment can vary based on the individual’s age and specific case. Treatment may include behavior therapy, medication, or a combination of both. Parent education and training are typically included in any treatment plan for children up to the age of 12. 

  • 4 – 5yrs old: Behavior therapy is the first line treatment before trying medication. This mainly involves parent management training and school interventions.
  • 6 – 11 years: A combination of behavior therapy and medication is mostly recommended.
  • 12 – 18 years: Medication, with the adolescent’s agreement, and possibly behavioral therapy

Types of Treatment 

Behavioral/Non-Medication Treatment 

This includes various types of therapy aimed at helping individuals with ADHD learn or strengthen positive behaviors and skills, unlearn negative behavior or thought patterns, and cope with daily challenges. 

Cognitive Behavioral Therapy (CBT)

CBT focuses on change problematic thinking pattern (cognitive change) and learning new, healthier behaviors (behavioral change). It helps individuals recognize and modify negative thoughts and behaviors, improving overall functioning and coping strategies.

Dialectical Behavioral Therapy for Adolescents (DBT-A)

DBT-A is a specialized form of cognitive behavioral therapy designed to treat individuals with suicidal behavior, self-harm, or other serious mental health issues. It is also effective for those with additional substance use disorders.

ADHD Coaching

ADHD coaching provides support for specific challenges, such as organizing daily tasks and managing time effectively. Coaches help individuals with ADHD develop effective learning strategies, improve social skills like communication, and take charge of their lives. 

Music Therapy

Music therapy benefits individuals with ADHD by helping them improve attention and focus and reduce hyperactivity. The structure provided by rhythm aids a brain struggling with self-regulation, and pleasurable music has been shown to increase dopamine levels, which further helps regulate attention, working memory, and motivation.

Art Therapy

Art therapy is particularly effective for younger children who have difficulty expressing themselves verbally. It helps hyperactive individuals to stay physically busy and focused through creative activities. 

Equine Therapy

Equine Assisted Psychotherapy (EAP) is an experiential therapy, involving interactions with horses. This therapy helps individuals with ADHD learn to regulate their body energy and understand non-verbal cues. Horses provided immediate feedback, which is essential for building relationships with horses. 

Parent Management Training  

Also known as parent training in behavior management this therapy is recommended for parents of children 12 years and younger. It equips parents strategies and skills to support their child’s development and manage ADHD symptoms effectively. 

Behavioral Interventions for School

Learning specialists or educational therapists work with children or adolescent to establish routines and organizational tools to complete schoolwork and minimize conflict. These interventions may include setting up a structured schedule, using visual aids, or breaking tasks into smaller steps.

Parent-Child Interaction Therapy (PCIT)

PCIT is used for younger children with ADHD and oppositional defiant disorder who exhibit challenging behavior patterns. This therapy involves both play and behavioral techniques, teaching parents new skills to improve their interactions and relationship with their child. 

Medical Treatment

Why take medication for ADHD? Research has shown that in individuals with ADHD, some neurotransmitters in the brain, especially dopamine and norepinephrine, are less available. By normalizing these neurotransmitter levels, ADHD medication improves many symptoms. While the medication doesn’t make symptoms completely go away, it helps reduce them, making life more manageable. The goal of ADHD medication is to improve ADHD symptoms and restore functioning at home and in school.

About three-quarters of all children and adolescents respond well to ADHD medication, which has been used long enough to be considered a safe treatment of ADHD. 

There are two main types of medication available, stimulants and non-stimulants.

Stimulants
  • Use
    • first-line medication: Stimulants are the best known and most widely used medications for ADHD.
  • Types 
    • Amphetamines (e.g., Adderall) and methylphenidates (e.g., Ritalin, Concerta)
    • Both types work slightly different in the brain, meaning one might be more effective than the other for some people.
    • Amphetamines are generally stronger than methylphenidates. 
  • How they work
    • Stimulants improve communication between brain cells by increasing the amount of neurotransmitters (dopamine and norepinephrine) and by preventing their breakdown.
    • Effects are usually visible within 30-60mins after intake.
  • Duration of effect
    • Different stimulants last for different amounts of time. Shorter-acting stimulants last about 4 hours, while longer-acting ones can last up to 10-12 hours.
    • Dosages may vary for each individual.
  • Possible side effects
    • Discuss potential side effects and how to manage them with your doctor before starting medication.
    • Contact your physician immediately if you experience heart symptoms like heart pounding, chest pain, or dizziness.
    • Other side effect may include
      • Loss of appetite and weight loss
      • Difficulty falling asleep
      • Dizziness
      • Increased irritability or moodiness
      • Growth problems
      • Headache
      • Stomachache
  • What to do in case of overdose
    • Signs of overdose include cardiac side effects and serotonin syndrome, which present as fast heart rate, sweating, tremors, agitation, high blood pressure.
    • ! Call 911 for emergency intervention or 1-800-222-1222 for medication overdose or poisoning in the U.S..
Non-Stimulants
  • Use
    • Often used if stimulants don’t have the desired effect or in combination with a stimulant.
    • Alpha agonists might be considered if there are other specific conditions like motor/vocal tics, aggression, or behavioral issues. 
    • Atomoxetine and Volxazine have been shown to be beneficial for individuals with other mental health challenges like depression or anxiety.
  • Types
    • Atomoxetine (e.g., Strattera)
    • Volxazine (e.g., Quelbree)
    • Alpha agonists like Clonidine (e.g., Catapres) or Guanfacine (e.g, Intuniv)
  • How they work
    • These medications decrease the breakdown of neurotransmitters (epinephrine and norepinephrine) in the brain, thereby increasing their levels.
    • These medications are usually titrated, starting with a lower dosage that is gradually increased until the desired effect is reached, and side effects are manageable. 
  • Duration of effect
    • It can take several weeks to see an effect when starting these medications. 
    • The duration of effect varies within this group, but they usually require 1-3 doses per day. 
  • Possible side effects
    • Non-stimulants are often less effective than stimulants, but side effects are less common.
    • Side effects may include:
      • Tiredness
      • Drowsiness
      • Sleep issues
      • Decreased appetite
      • Stomachaches
      • Headaches
      • Nausea
      • Irritability
      • Moodiness

Sometimes, stimulants and non-stimulants are used together to improve effects and reduce side effects. This combination of medication is quite common. 

Second-Line Non-Stimulants and Antidepressants
  • Use
    • Not as widely used as widely as stimulants and non-stimulants.
    • Mainly used in more complex cases such as individuals with ADHD and substance use issues or with a mood disorder.
Monitoring and Regular Use
  • Regular monitoring for improvement and side effects is crucial
  • Taking the medication regularly and attending all treatment appointments is essential.
  • Untreated ADHD can lead to severe negative impacts on an individual’s life. 
  • Consult with the prescribing physician before stopping medication.

For more information on medication in ADHD, please visit the AACAP website (link).

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