How is pharmacotherapy used to treat ADHD?

A group of drugs called psychostimulants are an effective treatment for ADHD. The two most commonly used medicines in this class are methylphenidates (often known as Ritalin) and dextroamphetamines (similar to Adderall). These medicines help people with ADHD focus their thoughts and ignore distractions. Stimulant medicines are effective in 70% to 90% of patients with ADHD. New medicines are also being developed.

Examples of short-acting (immediate-release), intermediate-acting and long-acting forms of these medications include:

Methylphenidates

  • Short-acting: Ritalin®, Focalin®, Methylin Chewable®, Methylin Solution®.
  • Long-acting intermediate release: Ritalin SR®, Methylin®, Metadate ER®.
  • Long-acting extended-release: Concerta®, Aptensio® XR, Metadate CD®, Metadate ER®, Ritalin LA®, Focalin XR®, Daytrana®, Quillivant XR® (liquid) Jornay.

D-Amphetamines

  • Short-acting: Dextrostat®, Dexedrine Tabs®, Evekeo®, Zenzedi®, Adderall®, ProCentra®.
  • Long-acting intermediate release: Adderall®, Dexedrine Spansule®.
  • Long-acting extended-release: Vyvanse®, Adderall XR®, Dyanavel® XR, Adzenys® XR-ODT.

Non-stimulant medicines include atomoxetine (Strattera®,) guanfacine (Intuniv®), and clonidine (Kapvay®). They are often used as additional treatment, or can be used on their own if the healthcare provider approves. New nonstimulant formulations are in the pipeline of several pharmaceutical companies.

There’s no way to really know which medicine(s) and dosage level(s) will work best for you or your child until you try it out. Your healthcare provider may need to prescribe several different formulations and see how you your or your child react. Typically the physician will “start low (in dose) and go slow.”

The most common side effects of ADHD medications include decreased appetite, trouble sleeping and irritability. Fortunately, side effects are often mild and short-lived and usually happen early in treatment. If they continue or interfere with you or your child’s daily life, your provider will probably change your medication or lower the dose. The most important question to ask is, “Does the benefit of the medicine outweigh the side effect?” The most effective treatment is medicine combined with behavioral therapy.

What behavioral treatments are used to treat childhood and adult ADHD?

The best prevention for ADHD, supported by substantial research, is to use a combined approach of both behavioral intervention and pharmacotherapy. Medicines are not enough to treat you or your child’s ADHD. The old adage — pills don’t teach skills — is certainly appropriate here. Thus it’s best to combine medical treatments with behavioral treatments.

Behavioral treatments for childhood ADHD include:

  • Behavior modification: With this treatment, your child’s behavior is analyzed, and strategies are designed to increase appropriate behaviors and decrease inappropriate behaviors. One model program for children with ADHD is called the Summer Treatment Program developed by Dr. William Pelham of Florida International University.
  • Behavioral parent training: This training helps parents respond to a child’s behaviors in ways that will strengthen growth and development and encourage a positive parent-child relationship. Parent training often occurs at the same time as behavior modification or social skills training for the child. A good parent training program is 1-2-3 Magic by Thomas Phelan.
  • Social skills training: This training teaches social skills that will improve the child’s ability to act positively and effectively with peers and adults in school and at home. It also provides a setting to practice the skills in a safe, accepting atmosphere.
  • School interventions: A specialist may work with your child’s educational team to conduct a multi-factored evaluation, or MFE, as noted above to create an individualized education plan (IEP), 504 plan or other classroom-based intervention.
  • Organizational skills training: This training teaches older children skills to help them improve time management, organizational skills and effectively use executive functions to increase efficiency and work completion at home and school.

Behavioral treatments in adults help you navigate the demand of jobs, relationships and educational opportunities. ADHD coaches are trained and certified to assist adults with ADHD to manage the various difficulties of their lives.

Behavioral treatments for adults with ADHD include:

  • Individual cognitive behavioral treatment (“talk therapy”) to enhance a person’s sense of self-efficacy.
  • Relaxation training and stress management to reduce anxiety and stress.
  • Behavioral coaching to teach strategies for organizing home and work activities.
  • Job coaching or mentoring to support better working relationships and improve on-the-job performance.
  • Family education and therapy to ensure that everyone in the family understands ADHD and its symptoms.

What happens if ADHD is left untreated?

Symptoms will continue if ADHD is left untreated and people are left to manage them on their own. Children may struggle at school, home and in social situations, and adults may struggle with work, education, interactions with friends and family and more. Untreated ADHD makes life harder than it has to be.

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