ADHD Treatments

Introduction

ADHD treatments are as varied as the people who take them.  Generally there are two types of treatment that those with ADHD have the option of taking.  These two treatments are pharmacological treatments (medications) and alternative or therapeutic treatments.  Depending on the patient's specific diagnosis, the doctor will prescribe a daily dosage of some kind of medication.  Specific medication options and effects will be discussed a little later in this article, but for now we will say that some of these medications are short acting and others are long acting.  There is also the possibility that the medication being received will need to be increased over time in order for the drug to have the desired effect.  Generally when people, and especially parents think of ADHD medications, their thoughts go directly to the possible side effects that can result from the consumption of such medications.  While it is true that side effects of ADHD medications can include weight loss, appetite changes, insomnia and nervous tics most individuals feel that the positive affects of taking the medications far out weigh the negative side effects. 

Because ADHD is a behavioral disorder, it is necessary to also provide the patient with treatment that is aimed at restructuring the behavioral habits of the individual.  The role of behavioral therapy is actually to modify the patient's thinking to the point where they can be diagnosed as free from ADHD completely.  Medications cannot cure someone of their ADHD.  Medications are only intended to control the symptoms of the disorder so that the patient can live a more normal life.  Ideally, the individual with ADHD will only need the medications that are provided for a short period of time because of the progress that they are able to make mentally in terms of being able to integrate various coping skills, suitable study habits and a sense of discipline and responsibility into their daily lives. 

ADHD medications

When you think of ADHD medications there are usually one or two name brands that come to mind.  But deciding whether or not the popular brands are right for you or for your child is the real question that those struggling with ADHD are faced with.  There have been recent strides in the field of ADHD medications.  For example, many of the newer medications have the advantage that they only need to be given once a day and can last for up to 12 hours.  This can provide children in school with a huge advantage as there is no need to take medications with them to school and risk forgetting to take them nor are there the disadvantages of having a drug wear off just as attention is needed most. 

According to the American Academy of Pediatrics, at least 80% of children will respond to one of the stimulant medications prescribed for ADHD.   So the challenge comes in deciding which medicine is best to try first.   In general, stimulants are considered to be the first treatments prescribed.  The next treatment that is tried is generally an anti-depressant.  Medication quantities and frequencies are generally determined by the weight of the patient and other factors such as whether or not the child is able to swallow a pill or must be given a liquid medication.  While weight is a determinant of quantity there is no standard amount of any given drug that is based solely on weight.  The prescribing doctor will simply use the weight and health history of the patient as a guideline as they start with a low dose of the medication and progressively work towards a higher dosage. 

Because you need to know and understand what the most commonly prescribed drugs are and what they do in order to make the best decision about treating your own ADHD or the ADHD in your child, here are some summaries to become familiar with:

1. Stimulants - Stimulants are prescribed because it has been shown that they increase brain activity and tend to increase a child's alertness and ability to pay attention.  Some common brand name stimulant drugs are Ritalin, Adderall and Concerta.  Stimulants also go by the name of psychostimulants.  A common misconception about stimulants is that they will only "stimulate" a hyperactive child more, when in fact stimulants actually have a calming effect in children and adults who have ADHD.  Common side effects that are specific to stimulants include mood changes, headaches, irritability, insomnia and loss of appetite.
2. Non-stimulants - Non-stimulant drugs are a relatively new introductions to the treatment of ADHD. Non-stimulants, such as the newly FDA approved drug, Strattera, increase attention and impulse control by monitoring a brain chemical that is believed to directly affect those behaviors. Side effects of non-stimulant drugs such as Strattera include moodiness, fatigue and decreased appetite.
3. Anti-depressants - Anti-depressants are designed to relieve one's anxiety level and to regulate mood.  Anti-depressants are commonly prescribes to those who have both ADHD and depression.  This association between ADHD is all to common for many factors that have to do with the poor self image and low self esteem that those with ADHD tend to have.  Wellbutrin is perhaps the most well known of the anti-depressant drugs.  Side effects of anti-depressants can include dizziness, weight loss and suicidal thoughts.

Psychological/Behavioral treatments

Medication only gives temporary support or relief of symptoms to the patient with ADHD.  So to conquer the disorder of ADHD more effort than taking your pills is required.  No one but the individual who has been diagnosed with ADHD can decide whether or not to put forth the effort to overcome it.  So it is unfair to put the responsibility for working hard to make a change on anyone but oneself.  Although children with ADHD will need the help of a parent in sorting out their thoughts and finding the motivation to change, adults with ADHD should and have the ability to learn as much as they can about their disorder and work hard to control and overcome the disorder. 

Although medication helps the majority of children with ADHD, as many as 20% derive no real benefit from medication.  Some children experience side effects that prevent them from receiving medication on an extended basis.  Some children with relatively mild ADHD can have their symptoms managed effectively without medication.  Trying to force medication on a child (especially a child who is old enough to formulate their own opinions regarding their treatment) can create more problems than it solves, including creating tension between the caregiver and the patient that can have devastating effects on the success of whatever ADHD treatment that is chosen. For all these and many more reasons, other treatments are more often than not necessary in order to effectively treat ADHD.

This is where behavior therapy or behavior management comes into play. Behavior therapy is basically a common sense approach to teaching children how to behave in socially appropriate ways.  In addition to behavior therapy there are several feedback approaches that are used as tools for effectively increasing children's attention.  Neurofeedback is an approach that uses electronic devices to help the child control their own brain wave activity.  In some cases the children participating in this approach were able to increase their inattention, impulsivity, and response time.  Interactive metronome and musical therapy uses feedback from sound to improve attention, motor control, and certain academic skills. There are other types of procedures and non-drug therapies your physician may suggest.  For example, some physicians suggest that daily massage therapy may help people with ADHD feel happier, fidget less, be less hyperactive, and focus on tasks. Other alternative approaches that may be helpful to those with ADHD include relaxation training, meditation, and music therapy.

Natural remedies

Many natural remedies for ADHD and ADD have proven to be equally effective as prescription medications in some patients.  Natural remedies have the added advantage of being far less likely to produce the same disturbing side effects as their prescription strength alternatives.  Because the base elements of most drugs are from natural substances, there is a lot of evidence to favor the use of homeopathic, herbal and other natural remedies for ADHD.  

Clinical trials have found some herbs and supplements, such as oral flower essence, ginkgo biloba, panax ginseng, melatonin, Scutellaria (also known as Skullcap), German chamomile, Gotu Kola, Avena Sativa (Oatstraw), Rooibos, Lemon balm, Valerian, Lobelia, Hawthorn and pine bark extract (Pycnogenol) may possibly have benefits for ADHD.  However this evidence is not compelling or predictable enough to warrant a formal recommendation from the FDA that herbal remedies be used for children with ADHD. 

Homeopathic and herbal remedies seem to work best with people of certain metabolisms and chemical make-ups.  So while one type of remedy might work well with one person, may not work well with another.  Many parents with an aversion to giving their children too many prescription drugs, find that incorporating herbal remedies to a slightly less aggressive prescription routine is a good compromise.  It is always best to consult with your doctor before starting even an herbal remedy as some substances will alter the effectiveness of other prescription medications that are being used.