A psychologist explains medication and more

When I was small in the 1980s, the people I knew with attention deficit/hyperactivity disorder were hyperactive boys who went to the school nurse at lunchtime to take their medication. Many people assumed that these boys would “come out” of their symptoms as teenagers or adults.

For most of the 200+ year history of the condition we now know as ADHD, it was considered a childhood disorder. Specialists began to recognize more widely that ADHD can also affect adults only in the 1990s, when scientific evidence showed that some people continue to experience ADHD symptoms into adulthood and this can profoundly affect their life.

Over the past 30 years, ADHD in adults has evolved from a barely recognized disorder to a well-established disorder with evidence-based treatment options. In my 20 years of studying and treating ADHD in adults, it has been exciting to witness and, in a small way, contribute to advances in evidence-based treatment for ADHD in adults. adults made by researchers around the world.

Living with ADHD

ADHD is a disorder with symptoms of inattention such as distractibility and disorganization. It can also include hyperactivity and impulsiveness in some individuals, but not all. ADHD begins in childhood and causes problems at school, at work and in social relationships. One study estimates that approximately 3.4% of adults worldwide meet the criteria for ADHD, and recognition of ADHD among girls and women has increased in recent years. ADHD symptoms are hereditary and are linked to the functioning of specific regions of the brain.

But the experience of ADHD is not entirely based on genetics. A person’s environment can influence how much ADHD causes problems in their daily life. Because ADHD symptoms overlap with those of other conditions such as depression and anxiety disorders, a careful, multi-step professional assessment is needed to accurately diagnose it.

There is no doubt that living with ADHD presents real and persistent challenges. But today, adults with ADHD have better access to information and more evidence-based treatment options. And there are scientifically-based reasons for optimism and hope in the effective treatment of ADHD in adults.

To date, the main strategies for managing ADHD in adults are medications and a type of therapy called cognitive behavioral therapy for ADHD in adults. Current evidence indicates that medicine is more effective in reducing ADHD symptoms in adults than therapy, but the research base for ADHD treatment is growing. And because they work in different ways, medications and therapy can be considered complementary tools in the adult ADHD toolkit.

AHDH Medication Options

When taken as prescribed, stimulant drugs are relatively safe and unlikely to be addictive.Shutterstock

The most common medications used to treat ADHD are called stimulants.

It may seem strange that drugs called stimulants are prescribed for a disorder that can lead to hyperactivity. ADHD stimulant medications work by increasing the availability of brain chemicals, dopamine and norepinephrine, in areas of the brain associated with attention and self-regulation. Stimulant medications, when taken by mouth as prescribed, are relatively safe and unlikely to be addictive.

The two main types of stimulant drugs are methylphenidate, sold under brand names such as Ritalin and Concerta, and amphetamine-family stimulants such as lisdexamphetamine, which carry the brand names Adderall and Vyvanse. Ritalin and Adderall are shorter-acting formulations – typically lasting around four to six hours – while Concerta and Vyvanse are designed to work for up to around 12 hours.

Common side effects of stimulants can include loss of appetite and weight loss, as well as headaches or sleep problems if taken too close to bedtime. Also, people with heart problems may not be prescribed these drugs because they can cause mildly elevated heart rate and blood pressure.

Non-stimulant drugs used to treat ADHD in adults include atomoxetine, which increases norepinephrine, a brain neurotransmitter, and bupropion, an antidepressant sometimes used to treat ADHD which increases both dopamine and norepinephrine.

A recent analysis found that these four types of medication reduced ADHD symptoms better than a placebo or a “sugar pill” over about 12 weeks. Amphetamine-based drugs worked best overall for adults, and methylphenidate, bupropion, and atomoxetine seemed to work slightly worse, but with little difference between them. Unfortunately, very few studies have followed patients for longer periods of time, so it is unclear if these positive results persist.

Several studies using health care datasets offer intriguing insights into the potential positive effects of drugs for people in real-world settings. These studies found a relationship between ADHD medication prescriptions and lower rates of depression, motor vehicle accidents, suicide-related events, and negative substance abuse-related events. Although not definitive, this research indicates the positive effects of ADHD medications beyond simply reducing symptoms.

Medication is not the right choice for everyone. Some people have unpleasant side effects or find the medications not effective. Because there is no way yet to predict which medication will work for which patient, adults with ADHD should be prepared to work closely with their doctor to try different types and doses of medication to find the one that works. offers the right balance of positive effects with minimal side effects. effects. The bottom line is that while medication isn’t a perfect solution, medication is an important part of the treatment toolkit for many adults with ADHD.

Specialized therapy for adult ADHD

While medications treat ADHD “from the inside out”, specialized ADHD therapy works “from the outside in” by helping clients learn skills and structure their environment to reduce the negative impact of ADHD on their lives.

In cognitive behavioral therapy, clients work with a therapist to understand the interplay between their thoughts, feelings, and actions and learn skills to cope with problems and achieve important goals. There are different styles of cognitive behavioral therapy depending on the problem the client wants to work on. These treatments are evidence-based while being tailored to each client.

Over the past two decades, researchers have begun to develop and test cognitive behavioral therapies specifically for adults with ADHD.

These specialized therapies help clients incorporate organizational and time management skills into their lives. They also typically help people incorporate strategies to increase and maintain motivation to complete tasks and combat procrastination.

Most cognitive behavioral therapies teach clients to become aware of the effects of their thought patterns on emotions and actions so that unhelpful thoughts can have less influence. While therapy for depression and anxiety tends to focus on overly negative thoughts, ADHD therapy sometimes targets overly positive or overly optimistic thoughts which can sometimes cause clients problems.

Therapy for ADHD? What to look for, what to expect.

The reasons for optimism

In 2017, my students and I conducted a meta-analysis, a type of study that quantitatively summarizes the effects of multiple studies. Using data from 32 studies and up to 896 participants, we found that, on average, adults with ADHD who participated in cognitive behavioral therapy saw a reduction in their ADHD symptoms and an improvement in functioning.

However, the effects tend to be weaker than those seen with medication. Cognitive-behavioral therapy appeared to have stronger effects on inattentive symptoms than on hyperactive-impulsive symptoms, and the effects did not depend on whether participants were already taking medication.

Although cognitive behavioral therapy for ADHD in adults appears to be a promising option for treating ADHD, unfortunately finding a therapist can be difficult. Because therapy for ADHD in adults is relatively new, fewer clinicians have been trained in this approach. However, clinician manuals and client workbooks are available for those interested in this treatment option. And telehealth can make these treatments more accessible.

And as has been the case with other forms of cognitive behavioral therapy, online health interventions such as app therapy could bring treatment directly into the daily lives of people with ADHD.

More targeted forms of ADHD therapy are on the horizon, including approaches specific to the needs of students with ADHD.

This article was originally published on The conversation by Laura E. Knouse at the University of Richmond. Read the original article here.

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