Human beings are rarely created in perfect form, so we all arrive in this world with unique differences. Some differences are blessings, others are handicaps. Poor vision, for example, is a common handicapping condition that affects millions of people throughout the world. I consider poor vision a condition of “human-ness.” People can also have other medical conditions such as diabetes, asthma, thyroid conditions, ADHD, etc.—all are well-recognized differences that can impair the pursuit of a normal lifestyle if not dealt with in some manner.
ADHD is characterized by a prolonged history of inattention, impulsiveness and sometimes variable amounts of hyperactivity. It is important to emphasize that all of these symptoms are normal human characteristics. Most of us are forgetful and inattentive at times. We all at times become nervous and fidgety, and we certainly are impulsive to some degree. It is part of our “human-ness.” ADHD, therefore, is not diagnosed by the mere presence of these normal and characteristic human behaviors, but by the DEGREE to which we manifest these symptoms. ADHD individuals have an over-abundance of these normal characteristics. They have less CONTROL of these behaviors and therefore a more variable and frequently poor outcome of their day.
WHO SHOULD TAKE MEDICATIONS, AND WHY?
If a person meets the clinical criteria for a diagnosis of ADHD and is not succeeding academically and/or socially up to age-appropriate expectations, medication should be a PRIMARY OPTION for therapeutic intervention. ADHD is a medical condition. Recent research out of Harvard University has documented an abnormality in the dopamine transporter system in the central nervous system of ADHD adults. (1) This transporter system is responsible for moving neurotransmitter chemicals from the synaptic space back into the nerve cell. ADHD adults have approximately 70% more dopamine transporter than non-ADHD individuals and thus appear to have an overactive transport system.
Returning to the vision analogy, there are a number of options open to an individual who has compromised eyesight. One option is to attempt to correct the problem by wearing glasses to improve visual acuity. Perhaps glasses will totally correct the problem or perhaps they will help only partially. After glasses are in place, we are in a position to assess what further problems are interfering with success. Then we can address these issues as well.
The opportunity to eliminate the symptoms of a medical condition partially or completely should be available to all. Many children and adults with ADHD benefit enormously from the use of medication. The medications that are in use today act as transporter blockers, thus serving to normalize this aspect of brain chemistry. Most families who understand ADHD and its clinical manifestations prefer to try medication as a PART of their treatment plan. Over 90% of individuals with ADHD will have a positive response to one of the medical treatments.
WHAT IMPROVEMENT SHOULD BE SEEN?
In the early 1930s, Dr. Charles Bradley noted some dramatic effects of stimulant medications on patients with behavior and learning disorders. He found that the use of stimulants “normalized” many of the systems that we use for successful living. People on medication IMPROVED their attention span, concentration, memory, motor coordination, mood, and on-task behavior. At the same time, they DECREASED daydreaming, hyperactivity, immature behavior, defiance, and oppositional behavior. It was evident that medical treatment allowed intellectual capabilities that were already present to function more successfully. (2, 3)
When medication is used appropriately, patients notice a significant improvement in control. Objective observers should notice better control of focus, concentration, attending skills, and task completion. Many individuals are able to cope with stress and frustration more appropriately with fewer temper outbursts, less anger, and better compliance. They relate and interact better with family members and friends. You should see less restlessness as well as decreased motor activity and impulsiveness. ADHD individuals often complain of forgotten appointments, incomplete homework, wrongly copied assignments, and frequent arguments with siblings, parents, spouses, workmates, along with excessive activity and impulsive behaviors. With medication, many of these problems dramatically improve.
It is very important to remember what medicine does and does not do. Using medication is like putting on glasses. It enables the system to function more appropriately. Glasses do not MAKE you behave, write a term paper or even get up in the morning. They allow your eyes to function more normally IF YOU CHOOSE to open them. You, the individual, are still in charge of your vision. Whether you open your eyes or not, and what you choose to look at, are controlled by you. Medication allows your nervous system to send its chemical messages more efficiently, and thus allows your skills and knowledge to function more normally. Medication does not provide skills or motivation to perform. Patients successfully treated with medications typically can go to bed at night and find that most of the day went the way they had planned.
Editor’s note: “You can’t notice small improvements or side effects without a monitoring sheet.” See ADDitude Magazine’s 10 Medication Fallacies even Doctors Believe See below for a few Response to Treatment Rating Scales.
Medication Effects Rating ScalesChildren and Adolescents or Adults – Record changes observed and any negative side effects Arlington Center for ADD
Licensed physicians, physician’s assistants or nurse practitioners can prescribe medications. This person may serve as a coordinator to assist with the multiple therapies often needed, such as educational advocacy, counseling, parent training and social skill assistance. Parents should look for a physician who has a special interest and knowledge in dealing with ADHD individuals. This professional should be skilled in working closely with families to try the many and varied medical treatments that are available until the correct therapeutic response is attained. Members of CH.A.D.D chapters are an excellent resource for referrals to appropriate professionals. (Editors note: See: Find Treatment and Support for this and other referral options.)
MEDICAL TRIALS
It is necessary to establish a team of observers to appropriately evaluate a medication trial. Gather information from sources that spend time with the patients. This might include significant others, parents, teachers, grandparents, tutors, piano teachers, coaches, etc. As gradually increasing dosages are administered, feedback is gathered from these observers. Various ADHD rating scales are available to assist in gathering factual data. The most important assessment, however, is dependent on whether the ADHD patient’s quality of success in life has improved. For this information, I find no scale takes the place of conversations with the patient and family members.
When evaluating patients during a trial of medication, it is important to maintain treatment throughout the waking day, seven days a week. Treating them only at school or in the workplace is totally inadequate. I need all involved observers, especially parents and/or significant others, assisting in the evaluation process. Furthermore, I want to know if treatment has an effect on non-academic issues. Recent studies have found that treatment is necessary for most ADHD individuals throughout the full day, thus allowing full development not only of academic or work skills, but also the all-important social skills that are utilized with friends and family. After the trial of medication, if positive results are evident, then the family and the patient can make informed decisions as to when the medication is helpful. Most patients need medication throughout the day and evening.
WHAT IS THE CORRECT MEDICATION?
At the present stage of medical knowledge, there is no method of predicting which medication will be most helpful for any individual. At best, physicians can make educated decisions based on information about success rates with individual medications. Over 80% of ADHD individuals will respond favorably to the stimulant medications, methylphenidate, and amphetamines. Both of these categories of medications may need trials to assess which is best. If one stimulant does not work, the others should be tried, for experience has proven that individuals may respond quite differently to each one. Other alternative medications are available including the non-stimulant medications for ADHD. Experience has shown that the non-stimulants are not as effective as the stimulants, but they more be better tolerated by some. Each family and physician must be willing to try different medications in order to determine the best and most effective therapy. This is the only way to find the appropriate medical treatment. In some children who have multiple diagnoses such as ADHD and depression, or ADHD and anxiety, or ADHD and Tourette’s syndrome, combinations of medications are being successfully utilized for treatment.
WHAT IS THE CORRECT DOSAGE?
If stimulant medications work, there is an optimal dose for each individual. Unfortunately, medical knowledge is not at a point where it can predict what the correct medication or dose will be. This is not an unusual circumstance in medicine, however. For a person with diabetes, for example, we must try different forms and amounts of insulin to achieve the best control of blood sugar levels. For people with high blood pressure, there are many medications that can be effective, and often a trial of multiple medications and dosages is necessary to determine the best treatment. For stimulant medications, there is no magic formula. The dose cannot be determined by age, body weight or severity of symptoms. In fact, it appears that the correct dose is extremely individual and is not at all predictable. Again, similar to people who need glasses, the kind of prescription and the thickness of the lenses are not dependent on any measurable parameter other than what the individuals say enables them to see well. The dose of medication is determined solely by what ADHD patients need to most effectively reduce their symptoms. One must be willing to experiment with carefully observed dosage changes to determine the correct dosage. The appropriate dosage does not seem to change very much with age or growth. Medication continues to work effectively through the teenage years and through adulthood.
With the non-stimulants, the dosage at the present time is calculated according to weight. These are the only medications for ADHD for which this is true.
WHAT ABOUT “NATURAL” THERAPIES?
At this time, there is no evidence that natural therapies are therapeutic. There are many anecdotes about various “magical” cures for ADHD, but none have been found to be valid. Remember: multiple anecdotes do not mean proof. Natural therapies such as grape seed extract, blue algae, biofeedback, magnets, mega-vitamins, diet, and other “natural products” have not yet shown any lasting therapeutic benefit. At this time traditional medical therapy is the most effective treatment for ADHD. This is quite similar to other medical treatments such as insulin, THE best form of treatment for Type 1 diabetes, or thyroid pills THE best therapy for an inactive thyroid gland. Furthermore, natural health food treatments are not regulated by the government and are therefore highly suspect for contamination. Please be cautious when experimenting with alternative therapies on your family members.
SUMMARY
Individuals with ADHD present with a variety of well-defined symptoms and behaviors. Medication may be extremely helpful in alleviating some of these symptoms and will allow the other therapeutic modalities to be much more successful. Families must be willing to work closely with their physician to identify the correct medications and establish the best dosage levels.
References:
Dougherty, D.D. Dopamine transporter density in patients with ADHD. Lancet 1999; 354: 2132.
Bradley, C. The behavior of children receiving Benzedrine. Am J Psychiatry 1939; 99: 577-585.
Bradley, C. Benzedrine and Dexedrine in the treatment of children’s behavior disorders. Pediatrics 1950; 5: 24-37.
For an excellent reference book regarding all of the medications that might be used for ADHD individuals, including not only medications for ADHD but also medications for all of the associated co-morbid conditions, please refer to the following book:
STRAIGHT TALK ABOUT PSYCHIATRIC MEDICATIONS FOR KIDS , Revised Edition 2004
by Timothy Wilens M.D.
Suggested Reading:
DRIVEN TO DISTRACTION by Ned Hallowell, MD
DAREDEVILS AND DAYDREAMERS by Barbara Ingersoll
UNDERSTANDING GIRLS WITH ADHD by Kathleen Nadeau and Patricia Quinn
UNDERSTANDING WOMAN WITH ADHD by Kathleen Nadeau and Patricia Quinn
TEENAGERS WITH ADHD by Chris Dendy
IS IT YOU, ME OR ADHD by Gina Pera (For couples where one has ADHD and the other does not)
About the author:
Reprinted with permission of Theodore Mandelkorn, MD, a physician with Puget Sound Behavioral Medicine, a clinic that treats teens, children, and adults with attention deficit disorder and related conditions. For further information visit the website at http://psbmed.com, or call 206/275-0702.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). These symptoms can make it difficult for a child with ADHD to succeed in school, get along with other children or adults, or finish tasks at home.
Brain imaging studies have revealed that, in youth with ADHD, the brain matures in a normal pattern but is delayed, on average, by about 3 years.1 The delay is most pronounced in brain regions involved in thinking, paying attention, and planning. More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall,2 and a brain structure important for proper communications between the two halves of the brain shows an abnormal growth pattern.3 These delays and abnormalities may underlie the hallmark symptoms of ADHD and help to explain how the disorder may develop.
Treatments can relieve many symptoms of ADHD, but there is currently no cure for the disorder. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
(Note: I’ve also posted this article as a series of shorter posts. See those here.
Symptoms of ADHD
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
Be easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty focusing on one thing
Become bored with a task after only a few minutes, unless they are doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new
Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
Fidget and squirm in their seats
Talk nonstop
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
Often interrupt conversations or others’ activities.
ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have ADHD because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, whereas children who have more symptoms of hyperactivity or impulsivity tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive symptoms just have disciplinary problems.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
What causes ADHD?
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.4,5 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
A study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.6
Researchers are also studying genetic variations that may or may not be inherited, such as duplications or deletions of a segment of DNA. These “copy number variations” (CNVs) can include many genes. Some CNVs occur more frequently among people with ADHD than in unaffected people, suggesting a possible role in the development of the disorder.7,8
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.9,10 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, have a higher risk of developing ADHD.11
Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.12 In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.13 Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.14
In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers whothought their children received aspartame.15
Food additives. There is currently no research showing that artificial food coloring causes ADHD. However, a small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. They may experience fewer ADHD symptoms on a diet without additives, but such diets are often difficult to maintain.12,16
How is ADHD diagnosed?
Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children or seems constantly “unfocused” or “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.
No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood brain disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, the referring pediatrician and specialist will determine if a child:
Is experiencing undetected seizures that could be associated with other medical conditions
Has a middle ear infection that is causing hearing problems
Has any undetected hearing or vision problems
Has any medical problems that affect thinking and behavior
Has any learning disabilities
Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.
A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.
The specialist also will ask:
Are the behaviors excessive, and do they affect all aspects of the child’s life?
Do they happen more often in this child compared with the child’s peers?
Are the behaviors a continuous problem or a response to a temporary situation?
Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.
Finally, after gathering all this information, if the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.
How is ADHD treated?
Currently available treatments aim at reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education and training, or a combination of treatments.
Medications
Stimulants such as methylphenidate and amphetamines are the most common type of medication used for treating ADHD. Although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior, thus reducing hyperactivity. In addition, a few non-stimulant medications, such as atomoxetine, guanfacine, and clonidine, are also available. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medications also may improve physical coordination.
However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.
Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so he or she doesn’t have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.
For more information about stimulants and other medications used for treating mental disorders, see the booklet, Mental Health Medications, on the National Institute of Mental Health (NIMH) website. The Food and Drug Administration (FDA) website has the latest information on medication approvals, warnings, and patient information guides.
What are the side effects of stimulant medications?
The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.
Decreased appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child’s doctor. Also talk to the doctor if you have concerns about your child’s growth or weight gain while he or she is taking this medication.
Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.
Are stimulant medications safe?
Under medical supervision, stimulant medications are considered safe. Stimulants do not make children with ADHD feel high, although some kids report feeling slightly different or “funny.”
Preschoolers are more sensitive to the side effects of methylphenidate, and some may experience slower than average growth rates. Very young children should be closely monitored while taking ADHD medications.17,18,19
FDA warning on possible rare side effects
In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data suggested that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications. Recently published studies, however, have not found evidence that using stimulants to treat ADHD increases the risk for cardiovascular problems.20,21
The FDA review also found a slight increased risk, about 1 in 1,000, for medication- related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include an initial health history, including family history, and examination for existing cardiovascular and psychiatric problems.
One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that children and teenagers who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take it.22If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child’s behavior every day. Ask other people who spend a lot of time with your child to tell you if they notice changes in your child’s behavior. Call a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.
Do medications cure ADHD?
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn better. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. NIMH-funded research has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs.23
Psychotherapy and Parent strategies
Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.
Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
How can parents help?
Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of “time-outs” may be used when the child’s behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.
Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child’s strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become overstimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps. Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child’s behavior.
Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups typically meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids Stay Organized and Follow Directions
Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.
Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
What conditions can coexist with ADHD?
Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:
A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
Tourette syndrome. Very few children have this brain disorder, but, among those who do, many also have ADHD. People with Tourette syndrome have nervous tics, which can be evident as repetitive, involuntary movements, such as eye blinks, facial twitches, or grimacing, and/or as vocalizations, such as throat-clearing, snorting, sniffing, or barking out words inappropriately. These behaviors can be controlled with medication, behavioral interventions, or both.
ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses. For more information on these disorders, visit the NIMH website.
Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.
How can I work with my child’s school?
If you think your child has ADHD, or a teacher raises concerns, you may be able to request that the school conduct an evaluation to determine whether he or she qualifies for special education services.
Start by speaking with your child’s teacher, school counselor, or the school’s student support team, to begin an evaluation. Also, each state has a Parent Training and Information Center and a Protection and Advocacy Agency (link works) that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. It will look at all areas related to the child’s disability.
Once your child has been evaluated, he or she has several options, depending on the specific needs. If special education services are needed and your child is eligible under the Individuals with Disabilities Education Act, the school district must develop an “individualized education program” specifically for your child within 30 days.
If your child is considered not eligible for special education services—and not all children with ADHD are eligible—he or she still can get “free appropriate public education,” available to all public-school children with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the nature or severity of the disability.
For more information on Section 504, consult the U.S. Department of Education’s Office for Civil Rights, which enforces Section 504 in programs and activities that receive Federal education funds.
Transitions can be difficult. Each school year brings a new teacher and new schoolwork, a change that can be especially hard for a child with ADHD who needs routine and structure. Consider telling the teachers that your child has ADHD when he or she starts school or moves to a new class. Additional support will help your child deal with the transition.
Do teens with ADHD have special needs?
Most children with ADHD continue to have symptoms as they enter adolescence. Some children are not diagnosed with ADHD until they reach adolescence. This is more common among children with predominantly inattentive symptoms because they are not necessarily disruptive at home or in school. In these children, the disorder becomes more apparent as academic demands increase and responsibilities mount. For all teens, these years are challenging. But for teens with ADHD, these years may be especially difficult.
Although hyperactivity tends to decrease as a child ages, teens who continue to be hyperactive may feel restless and try to do too many things at once. They may choose tasks or activities that have a quick payoff, rather than those that take more effort, but provide bigger, delayed rewards. Teens with primarily attention deficits struggle with school and other activities in which they are expected to be more self-reliant.
Teens also become more responsible for their own health decisions. When a child with ADHD is young, parents are more likely to be responsible for ensuring that their child maintains treatment. But when the child reaches adolescence, parents have less control, and those with ADHD may have difficulty sticking with treatment.
To help them stay healthy and provide needed structure, teens with ADHD should be given rules that are clear and easy to understand. Helping them stay focused and organized—such as posting a chart listing household chores and responsibilities with spaces to check off completed items—also may help.
Teens with or without ADHD want to be independent and try new things, and sometimes they will break rules. If your teen breaks rules, your response should be as calm and matter-of-fact as possible. Punishment should be used only rarely. Teens with ADHD often have trouble controlling their impulsivity and tempers can flare. Sometimes, a short time-out can be calming.
If your teen asks for later curfews and use of the car, listen to the request, give reasons for your opinions, and listen to your child’s opinion. Rules should be clear once they are set, but communication, negotiation, and compromise are helpful along the way. Maintaining treatments, such as medication and behavioral or family therapy, also can help with managing your teenager’s ADHD.
What about teens and driving?
Although many teens engage in risky behaviors, those with ADHD, especially untreated ADHD, are more likely to take more risks. In fact, in their first few years of driving, teens with ADHD are involved in nearly four times as many car accidents as those who do not have ADHD. They are also more likely to cause injury in accidents, and they get three times as many speeding tickets as their peers.24
Most states now use a graduated licensing system, in which young drivers, both with and without ADHD, learn about progressively more challenging driving situations.25The licensing system consists of three stages—learner’s permit, during which a licensed adult must always be in the car with the driving teen; intermediate (provisional) license; and full licensure. Parents should make sure that their teens, especially those with ADHD, understand and follow the rules of the road. Repeated driving practice under adult supervision is especially important for teens with ADHD.
Can adults have ADHD?
Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.
These adults may have a history of failure at school, problems at work, or difficult or failed relationships. Many have had multiple traffic accidents. Like teens, adults with ADHD may seem restless and may try to do several things at once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood.26 Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person’s history of childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a physical exam and various psychological tests.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
How is ADHD treated in adults?
Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.
Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD.27
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. The antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.28 Older antidepressants, called tricyclics, sometimes are used because they, like stimulants or atomoxetine, affect the brain chemical norepinephrine.
Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should discuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.
Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into smaller, more manageable steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Citations
Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation.Proc Natl Acad Sci U S A. 2007Dec 4;104(49):19649–54. Epub 2007 Nov 16. PubMed PMID: 18024590; PubMed Central PMCID: PMC2148343.
Shaw P, Malek M, Watson B, Sharp W, Evans A, Greenstein D. Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder.Biol Psychiatry. 2012 Aug 1;72(3):191–7. Epub 2012 Mar 13. PMID: 22418014.
Gilliam M, Stockman M, Malek M, Sharp W, Greenstein D, et al. Developmental trajectories of the corpus callosum in attention-deficit/hyperactivity disorder.Biol Psychiatry. 2011 May 1;69(9):839–46. Epub 2011 Jan 17. PMID: 21247556.
Faraone SV, Mick E. Molecular genetics of attention deficit hyperactivity disorder.Psychiatr Clin North Am. 2010 Mar;33(1):159–80. Review. PubMed PMID: 20159345; PubMed Central PMCID: PMC2847260.
Gizer IR, Ficks C, Waldman ID. Candidate gene studies of ADHD: a meta-analytic review.Hum Genet. 2009 Jul;126(1):51–90. Epub 2009 Jun 9. Review. PubMed PMID: 19506906.
Shaw P, Gornick M, Lerch J, Addington A, Seal J, et al. Polymorphisms of the dopamine D4 receptor, clinical outcome, and cortical structure in attention-deficit/hyperactivity disorder.Arch Gen Psychiatry. 2007 Aug;64(8):921–31. PMID: 17679637.
Elia J, Glessner JT, Wang K, Takahashi N, Shtir CJ, et al. Genome-wide copy number variation study associates metabotropic glutamate receptor gene networks with attention deficit hyperactivity disorder.Nat Genet. 2011 Dec 4;44(1):78–84. doi: 10.1038/ng.1013. PMID: 22138692.
Williams NM, Franke B, Mick E, Anney RJ, Freitag CM, et al. Genome-wide analysis of copy number variants in attention deficit hyperactivity disorder: the role of rare variants and duplications at 15q13.3.Am J Psychiatry. 2012 Feb;169(2):195–204. PMID: 22420048.
Nomura Y, Marks DJ, Halperin JM. Prenatal exposure to maternal and paternal smoking on attention deficit hyperactivity disorders symptoms and diagnosis in offspring.J Nerv Ment Dis. 2010 Sep;198(9):672–8. PubMed PMID: 20823730; PubMed Central PMCID: PMC3124822.
Froehlich TE, Lanphear BP, Auinger P, Hornung R, Epstein JN, Braun J, Kahn RS. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder.Pediatrics. 2009 Dec;124(6):e1054–63. Epub 2009 Nov 23. PubMed PMID: 19933729; PubMed Central PMCID: PMC2853804.
Millichap JG, Yee MM. The diet factor in attention-deficit/hyperactivity disorder.Pediatrics. 2012 Feb;129(2):330–7. Epub 2012 Jan 9. Review. PubMed PMID: 22232312.
Wolraich M, Milich R, Stumbo P, Schultz F. Effects of sucrose ingestion on the behavior of hyperactive boys.J Pediatr. 1985 Apr;106(4):675–82. PMID: 3981325.
Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children.N Engl J Med. 1994 Feb 3;330(5):301–7. PMID: 8277950.
Hoover DW, Milich R. Effects of sugar ingestion expectancies on mother-child interactions.J Abnorm Child Psychol. 1994 Aug;22(4):501–15. PMID: 7963081.
Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives.J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86–97.e8. PMID: 22176942.
Wigal T, Greenhill L, Chuang S, McGough J, Vitiello B, et al. Safety and tolerability of methylphenidate in preschool children with ADHD.J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1294–303. PubMed PMID: 17028508.
Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, et al. Stimulant-related reductions of growth rates in the PATS.J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1304–13. PubMed PMID: 17023868.
Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD.J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1284–93. Erratum in:J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):141. PubMed PMID: 17023867.
Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, et al. ADHD drugs and serious cardiovascular events in children and young adults.N Engl J Med. 2011 Nov 17;365(20):1896–904. Epub 2011 Nov 1. PMID: 22043968.
Vitiello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, et al. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD.Am J Psychiatry. 2012 Feb;169(2):167–77. PMID: 21890793.
Warning on Strattera for attention-deficit hyperactivity disorder.FDA Consum. 2005 Nov–Dec;39(6):4. PubMed PMID: 16671156.
The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder.Arch Gen Psychiatry. 1999 Dec;56(12):1073–86. PMID: 10591283.
Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B. Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder.Pediatrics. 2006 Sep;118(3):e704–10. PMID: 16950962.
U.S. Department of Transportation, National Highway Traffic Safety Administration, Legislative Fact Sheets. Traffic Safety Facts, Laws. Graduated Driver Licensing System. January 2006.
Post RE, Kurlansik SL. Diagnosis and management of adult attention-deficit/hyperactivity disorder.Am Fam Physician. 2012 May 1;85(9):890–6. PMID: 22612184.
Ramos-Quiroga JA, Corominas M, Castells X, Bosch R, Casas M. OROS methylphenidate for the treatment of adults with attention-deficit/hyperactivity disorder.Expert Rev Neurother. 2009 Aug;9(8):1121–31. Review. PubMed PMID: 19673602.
Wilens TE, Haight BR, Horrigan JP, Hudziak JJ, Rosenthal NE, Connor DF, Hampton KD, Richard NE, Modell JG. Bupropion XL in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled study.Biol Psychiatry. 2005 Apr 1;57(7):793–801. PubMed PMID: 15820237.
Vitiello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, Abikoff H, Molina BS, Wells K, Wigal T, Jensen PS, Greenhill LL, Kaltman JR, Severe JB, Odbert C, Hur K, Gibbons R. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD.Am J Psychiatry. 2012 Feb;169(2):167–77. PMID: 21890793.
Ghuman JK, Riddle MA, Vitiello B, Greenhill LL, Chuang SZ, et al. Comorbidity moderates response to methylphenidate in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS).J Child Adolesc Psychopharmacol. 2007 Oct;17(5):563–80. PMID: 17979578.
Republished from NIMH – “What is Attention Deficit Disorder?” – Retrieved May 26, 1915 – No longer posted online. They now use an “Easy to Read” article instead. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml National Institute of Mental Health publications are in the public domain and may be reproduced or copied without permission.
“Photo courtesy of Master Isolated Images/FreeDigitalPhoto.net” Modified on Canva
The core symptoms of ADHD are hyperactivity, impulsiveness, distractibility and inattention as evidenced by problems organizing, planning, procrastinating, and time management. But doesn’t everybody have these problems? Yes, but for the diagnosis to be applicable, the doctor will consider the severity and duration and the extent to which your problems interfere with the quality of your life. For a diagnosis, you must see a doctor who is knowledgeable in ADHD and related problems. The principle tool for diagnosis is the interview.
Before seeing your doctor, take some quiet time to think about what is really bothering you and write it down. (People with AD/HD often forget the key things to say). If your office looks like the aftermath of a hurricane and you feel depressed, be sure to tell the doctor both facts. You may be depressed because you can’t deal with the office, or your office may be a disaster because you are depressed. Which came first?
Medication
“Pills? I don’t take pills!”
Well, you aren’t alone. Many people feel that way. Consider for a moment. Do the pills make you a different person? Is it not you, if you take a pill? Who is the real you?
That person who loses his temper at the slightest excuse,
the nerd who walks past his best friend without saying “Hello”,
the wife who is too tired to clean up the mess and greet hubby with a smile and kiss when he comes home?
Or are you the smiling affable, competent person you know is inside trying to get out?
Let’s go back to our car. Do you expect your car to run without oil or gasoline? Would you drive a car that worked on two or three of its four cylinders? Your brain needs fuel.
Ideally, every brain would produce just the right amount of all the ingredients it needs, but there is no such thing as an ideal brain. Some brains are chronically undersupplied with the chemicals they need to function properly. Clinical trials have shown that medication is the most effective method of dealing with an under functioning brain
There are a number of medications available. Your doctor may need to try more than one, to find the right one for you. He will probably start with a low dose to see if you tolerate it and then increase the dose to find the most effective dosage and timing. So don’t be discouraged if you don’t get a positive result immediately.
When you start taking the medication it would be a good idea to keep a record of the time you take it and any sensations you may feel and the time when they occur. Be sure to tell your doctor about all the effects. Some unpleasant effects like a headache or dizziness may, in fact, be what are called rebound effects which occur when the medication wears off. The problem can often be resolved by changing the timing of the next dose or even by increasing the dosage. Help your doctor to know what’s happening and he can help you to find the best solution for you.
For information about medication, you must see a doctor who has experience with ADHD.
For treatment guidelines and which medications are available, see
A PHYSICIAN’S PERSPECTIVE on ADHD Medications by Theodore Mandelkorn, MD
Editor’s note: Not everyone wants to take medication or is helped by traditional ADHD medications. Nor is medication alone enough. Some type of outside intervention, however, is usually helpful. You may prefer to try cognitive behavior therapy, coaching, diet changes, supplements, mindfulness meditation or any number of holistic or alternative treatments. Many treat their ADHD with a combination of these, searching for the right mix. Please see the Pinterest boards listed below for examples.
Published by Sarah Jane Keyser, Copyright 2006, all rights reserved. Coaching Key to ADD
“Image courtesy of SalvatoreVuono-FreeDigitalPhoto.net” Modified on Canva
Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.
These adults may have a history of failure at school, problems at work, or difficult or failed relationships. Many have had multiple traffic accidents. Like teens, adults with ADHD may seem restless and may try to do several things at once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood.26 Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person’s history of childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a physical exam and various psychological tests.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
How is ADHD treated in adults?
Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.
Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD.27
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. The antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.28 Older antidepressants, called tricyclics, sometimes are used because they, like stimulants or atomoxetine, affect the brain chemical norepinephrine.
Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should discuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.
Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into smaller, more manageable steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
Republished from NIMH – “What is Attention Deficit Disorder?” – NIMH publications are in the public domain and may be reproduced or copied without permission.
“Photo courtesy of artur 84/FreeDigitalPhoto.net” Modified on Canva
Currently available treatments aim at reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education and training, or a combination of treatments.
Medications
Stimulants such as methylphenidate and amphetamines are the most common type of medication used for treating ADHD. Although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior, thus reducing hyperactivity. In addition, a few non-stimulant medications, such as atomoxetine, guanfacine, and clonidine, are also available. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medications also may improve physical coordination.
However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.
Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so he or she doesn’t have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.
For more information about stimulants and other medications used for treating mental disorders, see the booklet, Mental Health Medications, on the National Institute of Mental Health (NIMH) website. The Food and Drug Administration (FDA) website has the latest information on medication approvals, warnings, and patient information guides.
What are the side effects of stimulant medications?
The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.
Decreased appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child’s doctor. Also talk to the doctor if you have concerns about your child’s growth or weight gain while he or she is taking this medication.
Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.
Are stimulant medications safe?
Under medical supervision, stimulant medications are considered safe. Stimulants do not make children with ADHD feel high, although some kids report feeling slightly different or “funny.”
Preschoolers are more sensitive to the side effects of methylphenidate, and some may experience slower than average growth rates. Very young children should be closely monitored while taking ADHD medications.17,18,19
FDA warning on possible rare side effects
In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data suggested that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications. Recently published studies, however, have not found evidence that using stimulants to treat ADHD increases the risk for cardiovascular problems.20,21
The FDA review also found a slight increased risk, about 1 in 1,000, for medication- related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include an initial health history, including family history, and examination for existing cardiovascular and psychiatric problems.
One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that children and teenagers who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take it.22If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child’s behavior every day. Ask other people who spend a lot of time with your child to tell you if they notice changes in your child’s behavior. Call a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.
Do medications cure ADHD?
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn better. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. NIMH-funded research has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs.23
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
The pros and cons of medicating ADHD kids is a hot topic that weighs heavy on the minds of our clients and other parents. It’s been on my mind, lately, too. Here’s my perspective and my story.
My story:
I generally take a holistic approach when it comes to my family’s health. We prefer to eat organic whenever possible, and I tend to choose more holistic remedies for managing illness.
In third grade, when my son was first diagnosed with ADHD, I was adamant thatI would not medicate him. Even though I had been working in healthcare for many years, the idea of putting an 8 year old on a maintenance medication seemed extreme. I was convinced I would find an alternative, something other than what I assumed was a “brain-numbing” medication that I was convinced would turn my fun-loving daydreamer of a kid into a zombie.
Our Pediatrician was a saint. She was eternally patient with me, wanting to support my wishes. When I asked, she held firm on her perspective that medications have been proven to help most kids. Unless ruled out for some other clinical reason, she considered medication to be “best practice” for ADHD treatment.
At some point in the process, after hours of research and hair pulling, something she said to me stuck hard. “It’s clear that you want to do all you can for your son to help him be more successful. What if medication could work for him, but you weren’t willing to try it? Yes, there are potentially side effects, but typically they are not significant. He can always stop taking it if it doesn’t work, or the side effects are a problem.”
As a coach, we encourage our parents to use their values as a barometer for decision-making. Looking back, the values that were most important in helping me make my decision were: dedication to family, being responsible, striving for excellence, and being well educated.
I knew that I could always have my son stop taking the medication; but, if he never tried it, I wouldn’t really know if it would help him or not. Bottom line: I was committed to doing whatever I could to help my son. For me, that meant letting him try the medication and see what happened.
We were fortunate. The process of finding a medication “fit” was easy for us. The first medication we tried worked quite well, and its effects appeared instantly. He was like a new kid, literally, in a matter of hours. His side effects were mild and manageable. After that first week, I never looked back. It was clear to me that I had done the right thing for my son.
My son is now a teenager. Sometimes we end up in conversations about whether or not he has to take his pills, particularly when he’s not in school. He knows that they help, but sometimes he thinks that he would be better off not taking them. Ultimately he doesn’t like to feel “different.” That’s a big deal for most teens. I have compassion for how he feels. I also hold fast to the house rule that he take his medication (most of the time).
Here’s why I choose to medicate my ADHD son:
For my son: He has a neurobiological disorder of the brain, and medication definitely helps his brain to focus and to work more efficiently. If he had diabetes, I would never question whether or not to put him on insulin if he was an appropriate candidate.
For me: To be honest, it makes my life easier when he takes his medication. Being a parent of a special needs kid is more than challenging. It’s often overwhelming and highly stressful. Having a child that is a little more focused and a little less emotional takes some pressure off. It helps to support me in staying out of crisis mode, and in being more of the parent I know I want to be. It also helps me feel like I’m doing all I can to help him be successful. Yes, we can debate what it means to be successful, but that is a whole other blog.
For the other people in his life: Like it or not, society rewards people for “fitting in.” If you know me, you’ll know that I’m a huge fan of beating your own drum. I am also a realist. My parents always told me, “you attract more flies with honey.” I want my son to be attractive.
Ultimately everything comes back to my son. I know that he feels better about himself and his life when he feels more productive and connected, and when things are less of a struggle. He may not always remember this – after all, he is a kid with ADHD — so I get to be his mirror. When he is an adult, he’ll be able to make his own decisions. For now, while he is still under my direct care, I get the added bonus of knowing that I’ve made a powerful choice to support my ADHD kid!
By adulthood, ADHD can have a negative impact on major life activities, like financial problems, addiction, anger issues, even overeating… But help is available.
ADHD Awareness Minute – In honor of ADHD Awareness Month, we’re featuring a short video clip from Rick Green of Totally ADD. (3 minutes – Sorry, it took longer than he planned.)
TotallyADD – (Link works) ALL video site for adults with ADHD – A great place to start! Some pretty good Information and a lot of just plain fun. Quick videos address a number of common concerns of adults with ADD. Blog and ADHD screening tools. They add new material often and also offer FREE webinars that you can view at any time.Rick Green and Dr. Umesh Jain
Pay Attention – ADHD is not Just Me (3-minutes) Frank South tries to explain ADHD but gets distracted in a scene from his “Pay Attention, ADHD in Hollywood, on the Rocks, with a Twist.” Entertainer, comedian, and blogger for ADDitudemag.
The Art of ADD Manifesto “The Art of ADD is not about being normal or fitting it. Its about being ADD and using that medium to create a masterpiece out of your life. We don’t do life the normal way, we do it the ADD way!” (2 1/2 minutes)
Mad at Myself by Wes Bay (3 minutes) – Ever been mad at yourself? Well, it is time to laugh about it. Enjoy!
Touching 5-minute film about the triumphs and challenges of Adult Attention Deficit Disorder. “The Attention Movie” was produced by Thrive with ADD to help spread awareness of ADD / ADHD in adults.
My Life with ADHD – Videos about ADD/ADHD and random musings on life from an author, counselor, and coach with ADHD, Stephanie Moulton Sarkis Ph.D.
I have Adult ADHD?! – Tongue in cheek explanation of having ADHD with some pretty good information. Cartoon with some profanity as the narrator runs into some frustrating myths about ADHD while talking to his friend. (4 1/2 minutes)
Insider tips on lowering ADHD costs (Link works) by getting your insurance company to pay for medication, treatment, and other therapies by Jane Lehto
Reduce ADHD Costs with Patient Assistant Programs by Kimberly Holland
Find retail prices for the brand name and generic versions of Adderall and other popular ADHD medications. (Be sure to compare costs with your local pharmacies.) Try other cost-saving techniques, such as mail-order prescriptions and coupons.
A comprehensive collection of sources for help with medication costs – Post on Psych Central Forums. (Link works) – Repeats some of the sources listed below but provides additional ideas especially about generic medications. (URL: https://psychcentralforums.com/insurance-and-finances/153805-free-low-price-prescriptions.html#post1481620)
Help from Pharmaceutical Companies – Patient Assistance Programs
Eligibility varies program by program. Generally, individuals must have incomes under 200% of the Federal Poverty Level, cannot have prescription coverage from any public or private source and must be a U.S. resident or citizen. Some companies also require that the patient has no health insurance (including Medicare).
Note: These are non-profit sites and do not charge you for their help.
RX Hope has program descriptions and downloadable applications for prescription assistance programs for specific medications including psychotropic medications
Needy Meds – Just enter the name of your medication in the Drug Search box in the upper right corner.
RxAssist – Offers access to PHARMA programs for both doctors and consumers (877) 844-8442
Note: IF you need Vyvanse or Intuniv, Shire Care’s income criteria is significantly higher than the less than the 2x the poverty level required by most Pharma programs. You still need to provide proof of hardship however. Each application will be considered on a case by case basis. See Shire Care for more information and to apply.
Monthly paperwork for stimulant medications too much for you to deal with?
For a small fee, The Medicine Program.com will help you with applying for PHARMA programs and enlisting your physician’s help. – P.O. Box 520 – Doniphan, MO 63935-0520 – (573) 996-7300
ADHD Medications: PART ONE
About the author:
